Posting while waiting...

Sitting at the airport waiting for seester Sarah to arrive. Mom for in safely yesterday, picked up by a friend and deposited at my house so that when I came home from teaching (delicious eggplant from a coworker on hand) she had almost already finished the dishes!  

The personal assistant was back at it today, doing some grocery shopping and prescription pickup while I was at work. It's been a little crazy trying to prep for being out for at least a week, maybe more. Leaving lesson plans for coworkers who generously are covering classes, informing students, organizing work to be done from home. I still need to record a lecture for physiology tonight...I could wait till I'm hopped up in Percocet but that seems like a bad idea. 

After a quick visit in the office my mom and I headed for the plastic surgeons office for my "marking" appointment and photo shoot as well as post-op instructions from the nurse. No photos of that! Basically he drew all the incisions with marker and explained what comes off, what goes where. Prior to that, he took the "before" photos. The the nurse ran through how to deal with drains, handle pain pumps, what to do etc. I signed away my life on a consent and we were pretty much through. 

After the doc, we killed some time exchanging some of the button down shirts my mom had gotten me (no overhead motion if I can help it for a bit). After some retail therapy, it was here to the airport. After Sarah gets in we will do dinner (got to fill up since no food after midnight!) and head home. 

A lot of people have been asking how I'm feeling...I'm not nervous, more anxious and even a bit excited. A part of me (that comes from my dad) is just interested in procedure and looking forward to seeing what will actually happen. I wish I could get it videotaped! I'm also just interested to see what the recovery is really like and what the cheat with expanded feels/looks like etc. Same with the perky right side. 

People have been super supportive and sent so many good thoughts, so thanks!! I will be overnight tomorrow in hospital and not sure how with it I'll be but willl try to post at least a quick update or recruit one of my assistants to do so!  Then can update more while I'm chilling at home for the next few days. Hugs to all! 

More Complete Surgical PLAN!

Man, am I a planner.  It really does give me comfort.  The unknown is quite unsettling, so I'm happy to say that I have a plan moving forward.   I came to the coffee shop to get some work done, free from the distractions of my office and home, but I'll blog instead...how millennial of me. 

Last post recalled my MRI results and discussion with my surgeon to have the mastectomy.  After that point, it was on to figure out the whole reconstruction scenario that had overwhelmed me previously.  I made some calls and anxiously waited over the holiday weekend to schedule a second appointment with the plastic surgeon I had originally met with for today (Thursday).  Also, I had asked for the second opinion and had that appointment this afternoon...which I thought would work out well, because if the first one went well, I could just not go get the second opinion. 

Between last week and today, I did more research (probably too much) pulling articles, reading websites, etc.   And as today (and next week's surgery) got closer, I kept sort of hoping that I wouldn't have to change the surgery or anything like that.  The fact that Mom and Sarah's plane tickets got booked solidified that thought. 

Yesterday, Wednesday, I had my post-chemo follow-up with my medical oncologist.  After discussing the Flyers disappointing loss (so much for that Top 25 ranking) and relative merits of Garmin's activity trackers we talked about how Bertha was doing (though obviously he doesn't call her that...).  He off-hand mentioned that he thought highly of the original plastics guy and figured they'd do an expander at the time of mastectomy for reconstruction, which was somewhat reassuring to hear.  He also talked about how I'll now be taking tamoxifen daily, starting after I'm home from surgery.   

Tamoxifen is an estrogen receptor antagonist, meaning it blocks the places where the hormone estrogen binds to cancer cells (or at least the cancer cells I have, since mine are highly estrogen receptor positive...).  So for "high-risk" (advanced stage) PRE-menopausal women and many post-menopausal women, it's a recommended course of treatment for 5 years post chemotherapy.  So, yeah, woo hoo pills.  I was hopeful it wouldn't be that long, but if it can avoid a recurrence (the whole point of taking it), then sign me up. 

One hassle is that the anti-depressant I'm on can't be taken with it, because it can decrease effectiveness so I'll have to change to a different one, which hopefully won't be a huge deal (PS, the right drugs really are amazing...maybe some time I'll post in depth about how long I went before being willing to try them, and the difference they've made for me, personally). 

There are also fun side-effects with tamoxifen like continued night sweats/hot flashes and some other fun hormonal issues.  I have to be a bit cautious about clotting (long plane flights, etc...since I often say "sitting is the new smoking" hopefully this isn't much of a problem for me...speaking of which, I should stand up) and there is also a slightly increased risk of uterine cancer, but the benefit outweighs the risk.

After the appointment, I called Mom and basically just said:

"I'm over having cancer...."

and not "over" in the sense of "cured" but "over" in the sense that I was sick of it.  Sick of the appointments, the forms, copays, the unknown, the making of plans, etc.  It's more annoying that the chemo drugs themselves!  And hearing the extended Tamoxifen time (compared to what I had thought) was sort of the spoiled icing on the sugarless cake.  I went back to work, was a bit out of sorts, but kept trucking away.  Went home last night, called it an early night and just kind of said screw it.

 

This morning I woke up early because due to the appointment I was going to be late to my second class at noon and had to record some lectures so my undergrad TA could get the class started.  If you're feeling really bored and want to learn about membranes, feel free to watch/listen.  I finished basically just in time to teach at nine, run around sort of crazy for a bit of final prep for her, call Mom from the car, and make my way "three towns over" as my friend Adam would say (it's really just where I used to live, 20 min away) to the plastics office just in time to sit and wait for 25 minutes in the waiting room, learning about the Revolutionary War courtesy of the History Channel.  I tried to be patient, as I knew I had been a last minute addition to the schedule. 

 

When I was brought back, I took out my iPad, eager to take notes.  The doc came in, this time dressed in scrubs rather than the not so awesome sportcoat he had on last time.  I immediately got a better feel from him, and now that I had more information, we had a good conversation about options, plans, etc.  At that point, I decided to go for it with him, cancel the other appointment.  So, what you've been waiting for...here's what's happening!

 

Wednesday, Jan 28th in AM ~10am, go in for surgery:

 

Breast Surgeon: mastectomy of left breast, removal of chemo port, and sentinel node biopsy with possible axillary node dissection, pending biopsy findings.

Mastectomy and port removal are pretty straight forward.  The sentinel node biopsy is the dye procedure that the trace the drainage of the breast tissue, remove nodes and test for the presence of cancer.  If she gets clean nodes (pathology is run real-time), she's done, if it comes back showing cancer, or they can't determine it, they she dissects (cuts out) the lymph nodes under the armpit. 

 

Plastic Surgeon: right breast mastopexy (breast lift) and left breast tissue expander insertion

While the primary surgeon is doing the mastectomy, he'll do a breast lift on the right/non-cancerous breast.  Because the implant will sit higher and the radiation will "tighten" up the left breast tissue, a lift is needed to get the right one to match.  This is the free boob job part of it.  The right will still be subject to effects of gravity over time, whereas the implant won't, so given my age, a similar procedure may be needed down the road.  He does this first/at the time of the first procedure because it becomes the "target" for the other side.  It's also convenient because I'm already there, overnight in the hospital, etc. 

After the mastectomy is done on the left/cancerous breast, he'll insert a tissue expander.  This serves as a bit of a placeholder and will be filled with saline injections in his office over a period of a few months (probably 2x/week to try to do it "rapidly" over ~2 months).  At that time, he'll switch out for an implant.  After a week or so, I can start the radiation process.  After radiation, if anything else needs to be done to improve the cosmetic outcome or address any complication that arise with the radiation (which can definitely happen...a risk I'm willing to take), another procedure may be necessary.  The alternative to implants, my own tissue (back/lat flap), is sort of "saved" in case it is needed later...if he were to do that first, it might get damaged by the radiation. 

 

Based on what I've read, what the other docs have said, I am feeling good about this plan.  It seems reasonable and appropriate for me, and keeps me moving forward, which I've found to be pretty important for my sanity.  And, as much as I am a logical person, I usually do end up going with my gut, and this "feels" right.  As many weighted pro-con lists as I've made in my life, I'll admit part of the motivation for weighting them is it allows me to add in some intuition to my quantitative evaluation. 

 

After conversing with the plastics doc, I scheduled my "marking" appointment for Tuesday where he'll draw, take pictures, etc, and go over post-op instructions.  I'm glad Mom will be there for that one.  On the hurried drive back to campus to teach (thankfully was only 20 minute late) I called Mom and she was nice enough to cancel the second opinion appointment I had scheduled for the afternoon.  Distractedly finished teaching, then I just had to wait for the confirmation call that the scheduling would all work out for him to be in surgery at the same time, which is does, so I'm all set!

 

As the exclamation point in the title implies, I'm happy to have a more complete plan, and one that I feel good about.  Perhaps the excitement will turn into nervousness.  I anticipate a bit of "buyer's remorse" about it all as well.  But, so far, I think I've made good decisions when decisions had to be made, so am actually looking forward to this next step.  Side benefit, the big conference in March I go to can actually probably happen as I won't be in radiation yet!  And, I don't really have to worry about the trip to Phoenix I finally booked with MN friends for early March getting in the way (though oops, maybe I miss an expansion). 

 

I can't forget...I got another "welcome to cancer packet" yesterday in the mail (sidenote: that linked post was from 5 months ago yesterday...crazy what's happened since then) form the hospital where I'll have my surgery, complete with:

"pink stress relief ribbon which you can squeeze with your hand (optional)"

 

Another Lesson Learned: Don't ever stop laughing at the little things.

 



Surgical Plan and Lessons to Remember

Heard the results of my MRI from the surgeon yesterday...

...while the chemo has helped and things looks better, in her words, they aren't "great".  Specifically, the tumor is still fairly extensive; importantly, it is very near the nipple.  For those reasons, she recommends mastectomy to insure that the cancer is completely removed. 

So I'm losing a boob.

I was a bit relieved, as I'm somewhat glad the MRI pushed us in a given direction, rather than feeling like I actually had a decision to make.  And, while a mastectomy is more extensive, like everything, it comes with it's own sets of benefits: the risk of having to have 2 operations (in the case of a lumpectomy is margins turn out to not be 'clean'/free from cancer) is gone; reconstruction options abound; and there is slightly less of a risk of local recurrence (vs. lumpectomy). 

The surgeon left a message in the morning and we played some phonetag throughout the day, but I was able to chat with her after my psychologist appointment in the afternoon.  Seeing the shrink ended up being pretty well-timed, and it had been since before the holidays, so was a good opportunity to vent a bit.   I didn't have too many questions for my surgeon, other than asking about a referral for a second opinion on plastic surgeons.

The reconstruction issue is still somewhat in the air...I've been doing some research...

Hooray for institutional access!

 

specifically, reconstruction options when post-mastectomy radiation therapy (PMRT) will occur.  It seems like a topic that there's much discussion of in the literature.  Even in the evidence-based guidelines for practice from the American Society of Plastic Surgeons, the use of implants in the case of PMRT is lacking significant research.  There are some thoughts that any reconstruction, including the use of a tissue expander (inserted prior to the permanent implant to stretch the skin), can compromise radiation therapy and increase complications.  A few papers seem to suggest that the autologous tissue transfer procedures (using fat, muscle and skin from another part of the body), can lead to better results. 

 

So the plan moving forward in regards to reconstruction will be: 1) call to schedule a second consult with the guy I've already seen.  My surgeon does think he's the best, so now that I actually know what my surgery will be and can have a more directed conversation, I think it's worth talking to him again.  And, since I hate the phone, it's worth the trouble and copay to go into the office.  Plus, I plan on bringing what I've found so he can see why I may have some hesitation about any immediate reconstruction, which I think it what he recommended based on our original conversation...it was hard to keep straight with so many options.  2) I'll hopefully get an appointment soon with the other referral and see what they say as well.

 

Can you tell I'm trying to distract myself with the details and stay focused on the facts?  Don't worry, I've been trying to deal with the emotions as well.  I can't say I'm thrilled about the whole process, and am sure I don't really know how everything will feel.  As the reality was sinking in yesterday, I "coped"...put on sweatpants, emotionally ate, and did some masochistic movie watching...

 

 

Thanks Amazon for the ability to spend $2.99 to stream this.  It's based off the book I had already read, so I knew what I was getting myself into.  It worked, I cried a little...it helped things sink in  Lifetime knows how to do movies???  By the way, I have 4 licenses for download if anyone wants to watch it, let me know.

 

I ignored the calls from my sisters and wallowing in my self-pity for an evening.  And now it's the next day and I'm trying to move on.  I got my ass out of bed this morning for a bit of a workout.  While I've told the sob story, I also want to write something else, mostly at the urging of the shrink.  I've talked a bit about things that all this is teaching me and the lessons learnied and what better time to write some of those down than now.

 

Some Lessons I've  Learned So Far...

 

I used to say and think I was fat and out of shape...I wasn't.

How can I say this with some confidence?  Because right now, I am fat and out of shape.  Way more so that even those points in my past life when I felt this way.  I won't get into the dirty deets, but there are difference in how this size body feels compared to what I always thought was too big.  I will try to remember this in months when I'm back closer to my normal weight and frustrated about not being a "skinny" girl.

 

I am capable of relinquishing control and asking for help...and the world doesn't end when I do so.

Just yesterday I had to send an email to the old lab folks in Colorado about some additional data we're collecting for a paper that got rejected asking for resubmission.  Essentially I said "looks great, trust you guys, let me know how it goes", which was not easy because I'm a control freak.  But, I don't really have the energy and the time to invest in this particular venture more than that.  So yeah, giving up control, not easy but possible.  Regarding the help, while I've been fortunate to not need much, starting in the beginning and missing my first physiology class and having to ask someone to cover for me, it is possible for me to ask for help and people are willing to give in.  In fact, as I discuss with the shrink, it can actually help people to be able to help.  Everyone likes the feel goods. 

 

You don't know what you've got till it's gone. 

Any time you can quote an awesome 80s power ballad, you have to take it, right?  This is a pretty cliché lesson, I realize but that doesn't make it any less true.  When I lost my Dad I had similar thoughts, and this isn't different, although feels much more superficial.  Facing the fact that I'll lose a breast makes me think about "last times" on a lot of levels I definitely won't post about (Hi Mom!), but in general, I need to remember the unpredictability of life and loss and appreciate the moment.  Easier said than done, so a written reminder seemed wise. 

 

I'll likely keep adding to this list, but for now I'll stop there.  It's a new day.  There's breakfast to be made and eaten and work to do. 

 

I shared this video on Facebook but I'll include on here because it makes me smile and is one song I can't help but dance a bit to.  These kids are great and I especially like the freestyle part...we can all use a little of this in our lives, right?

 

Post by Heart North West.

Money, money, money...

Just for fun and to distract myself from waiting for the results of yesterday's MRI, I decided to look at my insurance claims since all this fun began...

Starting in August, the sum total includes the following categories; the procedures (biopsies, port placement); diagnostics (ultrasound, mammogram, MRI, CT scan); drugs (4 and 12 rounds of chemo); labs (lots of blood draws); and doctors visits...

$102,320

 

Pretty ridiculous.  Thank god my responsibility is about 100K less than that.

 

It may not be the best distraction, but it may be "healthier" than watching graphic mastectomy videos and looking at before and after pictures (DEFINITELY NSFW) as I was doing all day yesterday.

 

In other news, after negotiating with myself in bed for quite a long time, first at 4 am (should I just get up?) and then at 7:30 (should I just go to work?), I did manage a bit of a workout.

Oldie but a goodie

 

Yeah, I'm really out of shape.  But I guess I have to start somewhere...even if it's 25 minutes of breathing hard with 5 pound weights and stopping after 30 sec of jumping jacks.  Oh the wonder of detraining!

 

Classes have resumed as has the business of "regular" life.  Awkwardly announced the "situation" to my classes, forewarning them of missing some classes.  When I get nervous I just start rambling and staring into space so I honestly don't even really consciously know what their reactions were.

 

Back to trying to distract myself...



I Haven't Been This Happy About a Free T Shirt in A While

I'm sure most people have a lot of crappy tshirts lying around. And, if not, then at some point you probably did.  5ks or other races for the more athletic, family reunions, random company promotions, that sort of thing.  Some were given to you, some you "earned" by writing a check (aside...is that phrase going to get replaced at some point by "clicking a mouse?" "Swiping a card?" I wonder about these things...). Sometimes this happens up front, at the end, unwillingly after filling out a credit application (though I'd hope in the audience reading this there aren't many of those...). Well today folks, I got a t shirt.  And I'm going to say that while it was given to me somewhat in surprise, and I definitely paid for it (or rather Anthem Insurance paid for it), I'll say with some confidence that I did EARN it.  

HAPPY LAST DAY OF CHEMO!!!

It is kind of cute...the nursing staff anounces to the infusion suite that it's the last day and blows little birthday horns and give you the shirt.  It's not a big deal, which I get, because I can see how it might not be totally inspiring for some people, but it is nice.  

I'll back up a bit now but thought I'd lead with the excitement.  On Tuesday I saw a plastic surgeon for a reconstruction consult.  It went ok.  And yes, that statement was meant to be read without much fanfare (other interesting side note, I just attending a two day writing seminar and am breaking pretty much all the rules here...).  It may have been the doc, the overall thought of "plastic surgery", my attitude that day, but I just walked away underwhelmed.  

I should probably include a disclaimer at this point.  I'm going to talk about boobs for a bit.  Breasts, tatas, chickens, whatever you want to call them.  And, I realize some people (my brother, male friends, maybe some females, people that don't know me well) might be uncomfortable with this.  I get it.  So, if you are, stop reading or jump ahead, I'll make a point to highlight when I'm off the subject.  I'm not going to post my own pictures publicly or anything like that, though you can find real pictures of the real things online and it's actually helpful in some ways.  This was something I looked through an album of at my appointment in fact.  So yeah, breasts, it's been the topic of the blog before, but when you start talking size shape, nipples "it looks breast like" I just feel like it is sort of a whole new beast.  Hah breast beast...that'd be a funny cartoon villain. 

The surgeon pretty much jumped into making measures of my breasts after I briefly told him that the procedure was yet to be decided, which we both agreed makes the discussion a bit more complicated.  I think part of the reason for this might have been that the female nurse stayed in the room for this.  She recorded values but I also have to wonder if it wasn't just a male alone in a room safety/legal thing.  Which, considering the oncologist is a consistent doubles hitter in front of no audience, it makes me wonder if it's a plastics specific thing.  Maybe doctor specific.  If any doctor friends know, shed some light.

After making the measures which confirmed some slight sag previously recognized by me pretty much any time I'm naked, he kinda moved into discussing implants and their types.  Sidenote: I resume writing sitting in bed and eating Taco Bell.  I realize that probably sounds awful to some but is really awesome to me as it caps off a great night...more on that later...back to the boobs.  I Won't have to pick an implant type for a bit because the first step in an immediate (done at the same time as the cancer surgery) reconstruction is to put a tissue expander in.  This stretches the skin and creates the space for the implant to go. So the doc and I talked about this kind of stuff, looked through the pictures of his work (when he commented about how things looked "breast-like" and all the possibilities).  Since I don't have a ton of info on the surgical procedure, I didn't find it overly helpful...  Perhaps it is because I'm not extremely concerned about the aesthetics, I don't know.  I haven't ever really liked my boobs so I feel like as long as things are fairly symmetric (which means doing something to the other - right- one in most cases) and they fit in a bra and look okay in a shirt, I'll be alright.  In a lot of the books I read up front they talked about women's identities being in their boobs and while maybe I'll feel that way when they are changed, I don't know. But maybe I should also re-read those portions now that I'm faced with all of the surgery decisions.

Back to non-breast specific talk...I may seek a second surgical opinion after the MRI...I haven't really decided.  I like mine, but also am wondering if she's being too aggressive based on the initial diagnosis and not taking into consideration the effects of the neoadjuvant chemo.  For instance, if the sentinel biopsy comes back negative and we were to do a mastectomy, I'd still have radiation because that's the recommendation for stage three.  But am I really still stage three at this point?  Also, I'm considering a second plastics consult.  This guy didn't seem too keen on delayed reconstruction (treat everything then make it look good later on). The benefit to this approach is that the radiation folks can sort of better hit their spots if they aren't dealing with the tissue expanders, implants etc.  so look for an update next week after the results of MRI on what I decided to do re: second opinions.  

I got an email Wednesday or Thursday that my patient portal online account was updated and turns out it was notifying me of my surgery date of January 28th.  Got the confirming phone call today, so it is on the books.  Details to be worked out obviously but apparently that's where we are at as of now.  So, good to know.  The rest of those days were pretty uneventful, at the aforementioned writing workshop, working on materials for my interim review for promotion and tenure that is coming up and working at the store Thursday night.  Oh, and it was cold...like the rest of the country...yet people flip out about it.  Whatever.  

This morning, it was kind of fun to go through the check in process for chemo knowing that it wasn't last time.  I'll be in that building a lot (radiation is there too) but at least for a different purpose. 

 Treatment 12/12!

 When my nurse greeted me and said "happy last day" she was with another patient. Turned out to be that patient's first day.  Being able to say to her that I had my first day in the chair next to her and that what seemed like so long did go much faster than I would have thought I think out me in a positive mindset. Treatment was without event. 

Last bag hanging! I learned to prepare for the cold and had some great entertainment thanks to my nice Christmas present!

 I gave Deena my thank you presents I had put together and a card for my secondary nurse and they were both super appreciative.  Headed to office the met Corinne and Jen for a celebratory lunch.  Hanging out with those ladies is always a good time.

After heading back to the office to pick up the electronics I didn't want to leave in my car because of the weather I headed home to meet the delivery guy who had this:

Thanks mom! He's super cute! No replacement for you of course but nonetheless a nice gift.

After that I rested a bit then got picked up for more celebrations with friends.  Dinner at Mixteca the lovely authentic cheap Mexican where unfortunately they don't believe in heat during the winter (but you do get to BYOB so we got some Tecate from the brew through next door).  Speaking of drinking, mom was super encouraging of me getting drunk, even saying I could bring a trash can along so that if I puked I could contain my toxic bodily fluid.  While I had no intention of getting smashed, I did fully intend to break my oncologist-set two drink limit so started at dinner.

We then headed to Warped Wing Brewery to continue drinking a bit and also entertained ourselves with a few good rounds of oversized Jenga.

Fun stuff my friends. I had a flight and a couple of beers and found that perfect level of intoxication where you feel great, are loosened up,but not sloppy, get home at a reasonable hour and don't worry about waking up hungover.  I was a little worried at first given how out of practice I've been, but perhaps it's like riding a bike and there are some things you just remember... I requested the Taco Bell stop to cap off what was a great night and day with friends, celebrating the end of this stage without focusing on the disease.  Everyone around me seems to be okay with the balance I need and prefer and I'm so appreciative of that.  

I'm excited for a weekend not at the running store but will be busy enough with UD stuff and also catching some playoff football.  It's hard to believe the semester starts Monday as I am probably horribly unprepared, but given my track record am not overly worried that it'll come together.  

ALSO, big news that I didn't get to announce last post as it wasn't quite public yet...

SARAH AND JAMES GOT ENGAGED!!!

Congrats to sister Sarah and her fiancé James!!!

No details on anything yet other than everyone is happy and excited and looking forward to adding to the crazy and wonderful family.  I found out Monday on my kind of crappy day so it was such a nice thing.  I was also cheered up by lovely notes (including a perfect one from my big sis Karyn that she didn't even mean to send that reminded me that I do have cancer, and that it isn't all easy) from friends and family. 

So in the spirit of the love that will tie Sarah and James together, and the love that I have for all those who helped get me through and celebrate this first big step, I want to express my love and gratitude.  You guys are great.  

Deja Vu

Well, as far as I feel like I've come, today I feel almost as I did back in August...

Met with the surgeon this morning to discuss options and next steps.  Short story is that I need to have an MRI (got scheduled for next Tuesday) to really determine whether I can have a lumpectomy or will need a mastectomy.  She, like the oncologist is pleased with the softening and shrinking, but, depending on how the chemo has caused the tumor to shrink (eaten holes in it like swiss cheese vs eaten from inside out or outside in and kept the same shape), it can influence the ability to remove that tissue successfully with clean (non-cancerous) margins. 

Recurrence rates aren't that different between lumpectomy+radiation and mastectomy, so the determining factor is really the relative portion of tissue that needs to be removed and whether it involves the nipple, as to which approach is warranted.  We talked through risks, procedures, etc of both so that after the results come in, we can just chat on the phone.  Surgery will be scheduled for the last week in January, giving me a few weeks after my last chemo (this Friday) to continue to recover and build strength.  Both procedures, as long as they go well, won't take me out of commission too long in terms of work, which will be great. 

As part of either procedure, given the involvement of the lymph nodes, she'll do a sentinel node biopsy.  Essentially, a dye is injected so that they can map how the breast tissue drains.  They follow the dye to the first nodes and biopsy these to test, in real-time during the surgery, whether cancer cells are present.  If they can find at least 3 nodes that are negative, they stop at that point.  If they find less than 3 negative (can happen since they may be small post-chemo), or positive nodes, they continue with removing the entire area of nodes under the armpit. This dissection is what increases the risk of lymphedema (swelling of the arm) which you may have seen people wearing compression sleeves to help deal with. 

Given the unknown of the procedure, it means that the reconstruction options are also somewhat unknown.  There are differences as to whether it occurs immediately (during the same surgical procedure) or delayed (months or even years down the road).  Either way, I will discuss those details with a plastic surgeon, and that appointment is set for tomorrow.  So the silver lining of a "free" boob job is still a possibility...

After a bit of work at the office, I headed to my familiar Cancer Center but to see the Radiation Oncologist rather than my medical oncologist I've been under the care of.  The deja vu kicked in once more with...

...another welcome packet!

With both a mastectomy or a lumpectomy,  radiation is called for.  And, while I had done some research and knew a bit about it, I think this was probably my most ignorant aspect and I had underestimated exactly what would be involved.  Starting 4-5 weeks after surgery, when I am well on my way to healing of the surgical wound, we'll begin radiation treatments that occur 5 times a week for 7 weeks. 

That's a long f'ing time.

It's like another semester's worth (and yes I'll probably always track my life in terms of the academic calendar...). 

There are some associated risks and potential complications (thyroid issues, tingling, sore throat, etc) and there are restrictions during treatment (anything with bouncing of the chest or chafing of the arm and armpit...so no running...but I can bike with my arm up in the air...).  I guess the length of treatment is most frustrating...especially given the limitations for travel, etc.  I should be able to sneak my spring break trip in before it starts, but it'll put a damper on the major research conference that I attend, as I'm limited to weekend-only travel.  The prospect of an hour or so of my day there isn't overly exciting either, though I should be thankful that the center in convenient to home and work and that Dayton-area traffic is fairly non-existent.

After the appointment, I was just a little 'bummed' for lack of a more eloquent word.  I feel like I'm back at the beginning again...more doctors, explanations, diagnostic tests, waiting for results, making plans, etc.  And another 5 months ahead of unknown...physically, mentally, etc.  I am trying to remind myself that in addition to being poorer, fatter, and having less hair, that I have spent the last 4 months actively "fighting" this cancer...that the chemo did do something and importantly is making these surgeries possible and hopefully staving off any return of the cancer in the future from cells that might have snuck out and elsewhere in my body. 

I was ready to kind of get back to "normal" and I realize that I jumped the gun a bit.  The balance between being positive and optimistic and just avoiding thinking about reality is delicate.  Who knows, perhaps the next months will go as well as these past have, life will be minimally interrupted, and in 15 weeks I'll be blogging again about how I'm looking forward to my last treatment and can't believe how quickly it has come.  Let's hope. 

Despite the bit of a bummer day, I actually am remaining fairly positive.  Because, it could be worse.  Much, much worse.  I'm sure many people heard of the passing of Stuart Scott, the ESPN anchor who battled cancer for the past 7 years.  If you know me, you know I love ESPN, and Stuart was a talented broadcaster.  His catchphrases are his public legacy ("boo yah!" "as cool as the other side of the pillow", etc) and based on the moving tributes this weekend, he was truly one of those quality people.  Awhile ago, I posted Jim Valvano's famous ESPY speech about not giving up and this past year, Stuart Scott was honored with the Jimmy V Perseverance Award at the same awards show.  He gave a speech that I find just as moving and inspirational and takes on a whole new meaning now being in the cancer crowd.  I really encourage you to listen to the whole thing: Stuart Scott Video

The often quoted phrase which bears repeating...

"When you die, it does not mean you lose to cancer. You beat cancer by how you live, why you live, & in the manner in which you live" 

It's the Final Countdown...

Duh nuh nuh nuh, duh nuh nuh nuh....

One more chemo left! It is pretty exciting think that I am almost down with these twenty weeks of treatment.  The time seemed so daunting at the beginning that coming to the end is welcomed..  Though, as I have to remind myself, and have shared with others, there is still much ahead.  

In addition to another without incidence treatment on Friday, some other highlights of the week...

It was slow going coming off of vacation and trying to get back into the swing of work. Also, as I think I shared after getting back from Thanksgiving, I'm prone to a bit of "after family visit" let down, and this trip was no different.  It was a few long days of probably too much couch sitting and movie watching, especially since I didn't really have any early week obligations to pull me out of the house.  I did make it into the office on Tuesday for some work (hooray for my first interim tenure and promotion review coming up) and a nice lunch with the work guys.  

Wednesday I had a follow up appointment with the oncologist, here's the major takeaways...

-Dayton Flyers basketball is off to a good start

-My progress continues to be where he'd like it to be

-We set up a couple of upcoming (Monday) appointments

        -with the surgeon....will discuss procedure options (lumpectomy vs mastectomy, nipple removal or not), probably get an MRI ordered, hopefully set a timeline and potential date for surgery

        -with the radiology oncologist...this is the doc that supervises radiation treatments.  If I have a lumpectomy (and even possibly with a mastectomy), radiation afterwards is necessary to basically treat the borders of the removed area to help kill any remaining cancer cells.  From what I've read is usually five times a week for 4-6 weeks.  Can cause fatigue, local irritation.

So Monday is a double appointment day where hopefully I'll get a better idea of next steps...since I like having plan, that's great.  Especially since I haven't done my new syllabi and course schedules yet so knowing when I might be out of commission at work would be helpful....

After the appointment, I headed up to Columbus to spend some time with Andria since she had a rare two days off work.  We had an "exciting" New Years celebration binge watching The Mindy Project, barely staying awake till midnight (one redeeming quality of the eastern time zone to see the ball drop live), and running a couple errands. 

  Mmm killer brownies and sparking cider...

 I was home in time to get frustrated by the Watch ESPN sports crashing and missing the first hour of the first semifinal (more Mindy!) and then watching football.  While I'm definitely not an Ohio State fan, it keeps people in a better mood when the hometown team is winning.

 Thanks to Twitter I realized I wasn't the only one...

I got to see another visiting friend this morning, enjoy another Flyer victory at the Arena this afternoon and watch a wonderful video made by some old softball girls hat brought back great memories and made me again feel so loved! 

Random observation and accompanying pic...my eyelashes are starting to grow back and are stubbly and not really in a straight line right now! Kinda weird. 

Good luck to those who may be embarking on resolutions in this 2015...I'm not really one of those, here's my take on it...

I may do the jar thing, or even keep an electronic list, and yes hopefully "beating" cancer, whatever that means is on it. I got an email announcing that the Twin Cities Marathon registration starts in February (that's the one I missed this past October that Lex ran) and thought about whether I'll register.  Funny how things come full circle...I was doing a 20 week marathon training program last year when all this started, and like the treatment plan it seemed like a daunting task.  I might just welcome a plan like that this summer.