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Archive for the tag “surgery”

The Existential Job Search

I’ve been meaning for months now to write a post about how similar cancer and pregnancy are. Basically, your body isn’t your own, people are amazingly supportive, there is a ton of literature and personal stories of friends and acquaintances to take place of statistics and the unknowable. I was going to be much more in-depth and humorous, but that’s the gist of it. (Maybe I’ll get it right in the book. Should I do a book?)

My final point in the cancer-is-a-baby-you-never-asked-for theory–and the one that’s especially relevant for me now–is overestimating the “after.” When I was vastly pregnant with my youngest spawn I remember looking at thin people in magazines and on TV and thinking “as soon as I drop this load of baby I’m gonna squeeze my ass into that there miniskirt and drink five margaritas and DANCE!” etc. During chemo and surgery and radiation I had a lot of similar thoughts about how I was going to bound up out of this “sickness” and just be ON FIRE FOR LIFE! So full of energy and appetite and enthusiasm! Unstoppable!

Well, those notions were just as unrealistic as the post-baby ones. Six years later I have yet to squeeze into that there miniskirt (and at this point I think my miniskirt days are done even if I were svelte).

hit by a busI have been stuck in an existential quagmire. Thinking about what’s next and if anything is next. What I’m trying to say is that it’s hard to plan for an uncertain future. Yes, yes, I know “any of us could get hit by a bus tomorrow!” but honestly, when you say that to me it’s as if you’re dismissing my actual legitimate concerns. Here’s a cold, hard, fact: There’s a 30% chance that I’ll be dead in five years. That’s not me being a pessimist; that’s reality.

Now, I’m doing everything I need to do to be in the 70% on this. I’m still getting Herceptin infusions every three weeks through April, and I’ll be on hormone therapy (aromatase inhibitors) until 2021, and of course I’ll have annual mammograms.

But cancer is a sneaky, persistent little fucker, and if it feels like coming back, it’s going to.

So, I can live with that. But it’s hard to LIVE with that. It’s difficult to make long-term plans under that kind of cloud. For instance, I would like to go back to school. I’m 15 credits short of completing my bachelor’s degree and it’s something that I regret not finishing. BUT, what I’d really like to do is get a degree in something healthcare-related and that would require many many more credits than 15. But here’s the thing: How much money and effort and time I’d be studying and ignoring my family am I willing to spend if I only get five years? Or four? Or three?

But if I’m in the 70%, what if five years goes by and I’m cancer-free but I’m still at square one on that degree because I was too scared and worried to start something I might not be able to finish?

I’m having trouble bouncing back from this cancer business. Physically, my complaints are few: My armpit is still numb from surgery. My right boob is noticeably smaller than my left (both surgery and radiation contributed to this). I have scars and a medi-port. My eyebrows and eyelashes are sparse. Chemo brain hasn’t abated much. Luckily, I’m a writer, so when I can’t for the life of me come up with “calves” I improvise “shin butts.” My hair is coming in pretty well and I think it says “unfortunate haircut” more than “cancer” now.

Emotionally/psychologically? I’m having a rough time. Crippled with indecision, angst, and weltschmerz based on an unknowable future I turn to Samuel Beckett.

Samuel Beckett

“I can’t go on. I’ll go on.”

So, I’m taking baby steps back into the World, and I hope the World will welcome me.

 

 

Breast Cancer: The End.

It is done.

What began with a lump almost one year ago is finally over.

From the diagnosis

Turdy the tumor ultrasound

Darth Turdy

Through six rounds of chemotherapy

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Rocking the chrome dome during Round 3

Surgery on my breast and lymphnodes

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Damn you, cancer!

and 30 doses of radiation,

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this blog has been a place for me to collect my thoughts, sort out how I felt about what was happening to me, document the experience for the future, and sort of inadvertently–though in the end most importantly–help fellow cancer patients feel they weren’t alone.

I went from this:

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1st dose chemo. May 5, 1015

To this:

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Today. December 30, 2015

Thank you for going along for the ride. Thank you for not turning away from the ugly realities of scars and chemo shits, peeling nipples and weakness, doubt, and flat-out terror. You kept me going, readers.

What’s next?

First, the end is not the end. The day after my final dose of radiation, I was back at the hospital for an echocardiogram. I’ve got Herceptin infusions every three weeks until May. I’ll start a five-year hormone therapy treatment mid-January, and in the interim I’ll have a bone-density test and another MRI on the “good” boob. I’ll have diagnostic-level mammograms for the next three years. I told my daughter all this isn’t fighting cancer because the cancer is gone. It’s more like treatment that says “…And STAY OUT!”

IMG_4398Because of all this ongoing…stuff, it’s been sort of hard for me to call this “the end.” Then I received a fancy bottle of champagne from my dear friend Sara. I mean, how could you NOT celebrate with this? So I decided to stick a pin in this moment and create a milestone. This is the end of one journey. I made it. And now it’s behind me.

There WILL be a celebration. I’m still figuring out the details. Is it selfish to throw yourself a I Kicked Cancer’s Ass party? Would anyone show up? I want to celebrate it being over of course, but I also want to celebrate the friends and family and even strangers who made it easier.

 

Pathology, surprises, and what’s next

Since my last post I have calmed down a bit and also found out more information. The first thing I did was go to Dr. Supe’s office and pick up my pathology report. After much Googling, consultation with my billions of breast cancer books, and knowledge I’ve sucked up over the past six months, I had some answers. Then I had a post-op appointment with Buffy the Cancer Slayer and learned more.

Pathology Report post-surgery

Okay, so the good news is Turdy is dead. I will place no flowers on that fucker’s grave. But, I am grateful to him for being big and lumpy and close to the surface. If I hadn’t felt his gnarly ass in my boob, this cancer would probably still be undetected, spreading its shitty, sneaky doom throughout my body.

RIP Turdy

Let’s go through my list of Stuff I Don’t Know and update:

What I don't know

  1. Well, I guess that was rhetorical.
  2. Um…probably not. Here’s why: The nodes that drain from my breast to my armpit were discovered using the radioactive tracer. Dr. Supe examined three of them (the ones that made the Geiger counter click) and took out two. one showed signs that cancer had been there and been killed off by chemo. The other had some stubborn cancer still in it. (probably because the malignant node was so frickin large. Twice the size of Turdy.) So I guess the rest of the lymph nodes looked okay?
  3. A total of 7 grams. 4 for the former Turdy site and 3 for the little scoop where the DCIS was. Here’s what 7 grams looks like: 7 grams of weed
  4. Nope. Nothing left!
  5. We have to assume not, as nothing showed up in mammogram, ultrasound, MRI, or PET scan. My guess is that Turdy’s fat ass obscured the tiny 1mm DCIS. Could there be more? Sure. But we don’t have any evidence that there is.
  6. Buffy says that additional surgery wouldn’t be more lumpectomy or a mastectomy. The concerning area is my armpit, so if there’s more cutting, it would be to remove more lymph nodes. Or maybe all of them in my armpit. There isn’t consensus on that yet…
  7. Well. Because there aren’t many straight answers. Will the cancer come back? No one knows. You can look at stats and probability all day and night but you just can’t predict recurrence. It’ll come back or it won’t. And then you’ll know.

Here are some more things I’ve learned and realized in the last week:

  • When Dr. Moviestar called in March to tell me my biopsy was bad news and that yes, it was cancer, he told me it was Stage 2. Of course that was before a zillion more tests and scans. What no one told me (and I guess I didn’t ask, though I did speculate) was that once Turdy Jr. was discovered in my lymph node, my breast cancer was Stage 3. Which is scarier than Stage 2 and maybe it’s better I didn’t know until I flat-out asked Buffy. Still. Yikes! The survival rate takes a pretty large dip between Stage 2 and Stage 3. From 93% to 72%.
  • I think my terrible reaction to Dr. Supe’s phone call about the path report is due to unrealistic expectations. I expected to hear something along the lines of “you are cancer-free” or “there’s no evidence of disease.” Which equals remission. (Cancer is never “cured.” Sort of like addiction; substitute “remission” for “recovery.”) Why did I think that? Partially I think because my doctors never discussed possible outcomes with me. Never gave me a range of what could be the result. Did I ask? Maybe not. What I did do, a few months ago, was watch Season 4 of Parenthood in which Kristina Braverman gets breast cancer, goes through treatment and SPOILER comes out the other side healthy. parenthood-monica-potter-peter-krauseShe and her husband Adam sit in her doctor’s office after surgery and chemo and he tells her “You are cancer-free.” (Or that’s what I remember happening). So, to me, that’s how the narrative goes. Prince Charming rides up, kisses your dead lips and BAZINGA! Princess Life! Naive? Yes indeed.
  • I asked Buffy if one more round of chemo would have knocked out the remnants of Turdy Jr in my lymph node. She told me that I’d had the most chemo I could have. So I felt relieved that I hadn’t taken Dr. Cap up on his reluctant offer to lower my dose. And also felt a little bit badass. Like I took all there was to take. My chemo was dialed up ALL THE WAY and I got through it. Go me.
  • What I kept focusing on was the presence of cancer. A tiny DCIS in my boob and some extra-stubborn cancer in my lymph node. Forgetting the fact that those two bad boys were cut out of my body. Not inside it any more. Gone.

So here’s what’s next. Tomorrow, all my doctors (Supe, Cap, Buffy, the radiation oncologist, and whoever else) will review the pathology in a “multi-disciplinary breast conference” and discuss what they should do with me. Yes, it’s every woman’s nightmare: people who have seen me naked will be talking about me behind my back. They’ll discuss the armpit surgery and if they think it would make me healthier/safer/less likely to have a recurrence than just going ahead with radiation (which starts soon), continuing Herceptin until May, and hormone therapy (which starts after radiation ends and lasts five years). One of those Super Friends is supposed to call me after the meeting and let me know what went down.

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To be honest, I am more leery of the armpit thing than a mastectomy. The more lymph nodes you take out, the greater the risk of lymphedema, which apparently sucks big donkey balls, and they can’t do much about it. But, it’s not like I get to choose. My armpit is being a dick, not my boob.

As for the surgery recovery, Buffy snipped my little stitches and even I have to admit I am healing like Wolverine.

FullSizeRender (9)I still can’t immerse my boob in water for two more weeks and she warned me not to lift weights (ROFL). The grody part of my fingernails is growing out and should be gone in another month or two.

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My hair…well, let’s just say it’s slow going. I still haven’t had to shave my legs.

The chemopause is worse than ever. The hot flashes are pretty fucking terrible. Buffy says that given my current age and the age my mom was when she started menopausing, I probably won’t come out of chemopause, but will just slide right into legit-old-lady-menopause. So, yeah. It’s not like I was going to have more kids, but this is kind of a tough one. However! She told me that exercise and acupuncture can help with hot flashes, and if those don’t work she or Dr Cap can prescribe something for me.

I still have a terrible battery-acid pine cone in my belly. Well, that’s what it feels like. I chalked this up to chemo nausea long ago, but the chemo’s been over for two months today (!) and the pine cone is still there feeling prickly and gross. I think it’s a ball of anxiety and my next step (well, one of my steps in there amongst radiation and Herceptin infusions) will be to maybe talk to a shrink about that shit.

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Meanwhile! I have lots more energy than I used to. I changed the sheets on the bed without getting winded and I’m doing almost all the stuff I did before. I can eat food and smells don’t bother me and I’m excited about stuff. Like the Star Wars trailer, and my new kitten Loki, and the Halloween party I’m going to this weekend.

Loki Day One

Good news and the cost of cancer

First of all. MY  PET SCAN IS CLEAR! aka there are no signs that the cancer has spread to any other organs. It’s still there in my boob and lymph nodes but I’ll tell you what–if you want one cancery boob to seem as delightful as Thor in a G-string, spend a a few days pondering a stage IV situation.

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So,  yeah. I’m doing the happy dance right now. And I have to give massived kudos to my oncologist Dr. Cappuccino (who henceforth will be known simply as “Dr. Cap” for Captain America because he’s going to save my life) for sending me a message at 11pm last night to let me know the good news. Let me set the scene for you: After coming home from the PET scan, I pretty much went to bed. I was too worried and freaked out to function at all. I know that sounds dramatic, but aside from the BRCA-negative, I have flunked every test I have taken on this journey. This week I read two accounts of women who started with my exact flavor of breast cancer (ER+/PR-/HER2+) and were relieved it was caught early and did everything they were supposed to…and yet. Their cancer spread and they’re dying.

So I’m in my bed. The house is quiet. My husband is snoring beside me and the cat is sleeping on my knees. I can’t sleep because my mind won’t stop spinning horror scenarios. I’m telling myself “If I can just live another 10 years the kids will be okay. They’ll be 33, 29, and 15 and they’ll miss me, but they won’t need me.” I’m pondering getting up to take a Tylenol PM, but don’t want to disturb the cat. I mess around with my phone and I see from an email that I have a new test result. I’m not waiting on anything except the PET scan and I quickly log in to read this message:

Hi,
Pet scan does NOT suggest any areas of cancer spread outside the breast region.

– Dr. Cap

I shake my husband awake. “Honey, honey. It’s clear. The PET scan is clear!” I shove my phone in his sleepy face.

And there was much rejoicing. rejoicing

So, now back to the task of kicking this cancer to the curb. I have a post-op appointment tomorrow so Dr. Boobcutter can check my Mediport (which itches like a motherfucker, which I guess means it’s healing?), then the MRI-guided biopsy on my left boob on Monday, then chemo begins Tuesday May 5.

tequila IV

I’ve talked about insurance and approvals and such, but I haven’t really mentioned the costs of the care I’ve been getting. Let me be crystal clear, I am not complaining. I’ve paid very little out of pocket and Tricare has approved every single thing my medical team has submitted. But let’s take a look at the cost of breast cancer for JUST ONE WEEK:

  • April 22 – ultrasound guided biopsy of lymph nodes – $4,151.22
  • April 23 – surgery to install Mediport – $17,264.98
  • April 23 – anesthesia for surgery – $949.74
  • April 24 – echocardiogram – $2,166.00
  • April 29 – PET scan – $5,050.50

scrooge mcduck moneyThat’s almost 30k in one week! And I haven’t even started treatment yet!

Lymph Nodes, PET Scans, and Lies

breast_stageIIb_large2I wanted to write this post last week, but was feeling too Percocet-y. And now I find that I am reluctant to put words to it. I don’t have any especially staggering news to report. As expected, the cancer has spread to my lymph nodes. Four of them, according to Buffy the Cancer Slayer. Which is a weird thing because if it was three lymph nodes, I’m safely still in Stage 2, albeit I get a slight bump from 2A to 2B.

With four bad nodes though, I may be upgraded to Stage 3. No one with any authority has re-staged my cancer, but I’ve spent quite a bit of time consulting my books and the almighty Internet. Honestly, the stage isn’t going to make a difference in my treatment (I don’t think) because we’re starting with the big guns (chemotherapy) in the first place. Will it be more likely that I have a mastectomy than a lumpectomy? I don’t know, honestly. I guess some of that will depend on what, if anything, shows up in my left boob, which hopefully will have an MRI-guided biopsy this week. And if we’re tracking the fucks I give, I have none to spare for my rack. The ladies served me well and I’m totally okay with being rid of them if it keeps me alive longer.

I’m rambling, I know. Here’s what’s gone down since my last post:

Two days post Mediport surgery.

Two days post Mediport surgery.

Thursday I had surgery to install the “power port” in my chest. I was given the choice between “twilight” anesthesia or “knock me the fuck out” anesthesia and I selected door number two. Boy was I glad I did, because a forty minute procedure ended up taking two hours. Apparently I have a very robust collarbone and so Dr. Boobcutter had to dig around quite a bit to find a good path to my vein. Anyway, I guess all went well. I went home that afternoon with an ice pack and a Percocet prescription and a sleepy head. For the next twelve hours I felt dopey and headachey and kinda barfy. And I’d only been home an hour before Buffy called to give me the word on my stupid lymph nodes.

Dr Cappuccino, my oncologist called just a little bit after that. He said that he and Buffy and Dr. Boobcutter had been conferring and they’d decided that I should push back chemo a few days so that we could get that MRI-guided biopsy on my left boob and a PET scan. He said that some other people were pushing for a bone scan as well, but he was on the fence on that and thought the PET would be enough to see what’s what. “Hang in there,” he said. “We’ll get you through this.”

That afternoon at school my daughter was crying on the playground so her friend Jasmine took her to the “recess lady” who, when my daughter sobbed “My mom has cancer!” took her to the school counselor. There she got some stickers and drew this picture.

It says "Cancer is 1,000 pieces of poops."

It says “Cancer is 1,000 pieces of poops.”

Is it weird that I didn’t get a call from the school? Is my kid high-maintenance? When she cried again that night “I wish you never had cancer!” I decided that I’m out of my depth on this one. I left a message with the oncology social worker to see if there is a support group or a therapist I should be sending her to.

Friday I spent most of the day in bed except for a trip back to the hospital for my baseline echocardiogram. The drugs in my chemo cocktail that target the HER2 antibodies are known to play a bit fast and loose with the left ventricle, so we needed to check mine out so we can track any damage (which is temporary in the majority of people). So of course, I’m sitting there thinking…every fucking thing they’ve checked (minus my DNA, which does NOT have the breast cancer gene!) has been bad news. So I’m like “does my heart look normal, ha ha?” And the tech of course isn’t able to make a diagnosis–only the doctor can do that. So that freaks me out and  I become the Liz Lemon of the echocardiogram. “Hey look, Gunny, I DO have a heart!” “Is that my aorta or the sarlacc pit?” Ba dum tish.

sarlacc-pit

Then all weekend I looked up stats about how that one extra node effects my prognosis. And I get shit like this.

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Five year survivalWhat do I believe? Who do I trust? Am I being alarmist? Probably. But there’s enough concern to look at the rest of my body for more cancer.

So last night my son was over for dinner, milkshakes and Game of Thrones. And when the show was over and he was getting ready to leave we were chatting and I tell him chemo now is going to start on May 5 [insert joke about tequila in the IV for Cinco de Mayo] and he laughs and I follow with “Of course, that’s because they found more cancer and I have to get a PET scan har har.” And Allison, who is clinging to her brother’s leg like a tick–and who I apparently failed to notice–says “They found more cancer?”

“No,” I said. “No, I was just kidding.”

What stage of cancer involves lying to your kids?

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