Interesting Read - One Year Later

Daria, over at Living with Cancer, recently had a post in which she looked at her posts from a year ago to see what her state of mind was. I've done that before with this blog. I just did it tonight.

It's interesting. A year ago, I was just returning to work, after taking two weeks off to recover from breast reconstruction surgery. I seemed like I was in good spirits and I wasn't in a lot of pain.

I should say that post-reconstruction, I still feel some tightness (not sure how else to describe it) in my abdomen from the TRAM flap (where they released the TRAM muscle and brought up my tummy fat to the breast area).

Also, parts of the skin around the TRAM does feel numb.

I have a corner of flesh (literally, a corner) on the left end of the scar where they took my tummy fat - someday, I'll ask my plastic surgeon Dr. H to take it off. However, there's a month recovery afterwards . . . and I just haven't been motivated enough to do it and wait for a month.

My boobs are lopsided - the left side has dropped a little bit, but I don't think it'll ever drop to the level of the right side.

I have a big scar around my belt line and also the whole way around the (now) right breast. Someday, I may at least get areolas tattooed and also design some kind of tattoo to cover the scar that would show with lower necklines.

So, am I glad I had reconstruction surgery? Absolutely. Especially on the right side, where I now have a boob made of tummy fat. It used to be an open skin wound - and I had to change the dressings, sometimes a couple of times a day and toward the end, about once every three days.

I am also glad that I have breasts now. I don't feel self-conscious, like I did when I was absolutely flat on one side. Well, I feel a little self-conscious because they're lopsided, but most days, it's not that noticeable. They are smaller than they were before. But that's partly due to the fact that I didn't have ENOUGH tummy fat. I do wish they looked more normal than they do. My right side looks just like a blob of flesh, not really breast-shaped. The left side (with the implant) has a little fold of skin under it, I think because the tissue expander on the left was expanded a little bigger than what I received for a permanent implant - necessary in order to try to match left and right side more.

But all in all, I'm glad I did it. I am so happy I don't have to worry about the open skin wound. I'm also happy that, with clothes, I have almost normal boobs. Better than the alternative!

So, what's happened in the last year? A lot of good things (travel to Norway - twice; England - once; trips with family; meeting new friends and keeping old ones; some spiritual growth; living in the moment). Some bad things (cancer spreading to the lungs; trying new treatments; more fatigue; physical limitations - swollen lymph nodes and occasionally rib pain). But I'm here. I'm happy. I'm still working, doing things I [mostly] like to do. Overall, I couldn't ask for a better support system: my family, my friends, my colleagues. Thank you all!

Random Thoughts

I've haven't been blogging much lately - I was busy last week with guests and this week is Finals Week, so am busy with grading and a myriad other administrative tasks like recommendation letters, information requests from various committees, etc.

I won't be blogging much next week, either, because I will be in Bergen, Norway! I leave Sat evening and Scott is coming with me. We arrive Sunday afternoon and I presume we'll be wiped out by that time. Monday the 23rd is free, so we'll get a chance to wander around and then I'll have meetings from the 24th to the 26th. It'll be cool there, as they are at a little higher latitude than I am. I think temps should be in the mid-40s. But a change of pace will be really nice.

I'm feeling pretty well. My abdomen is still a bit tight, but other people aren't able to observe it as I stand fairly straight. If I twist, I can feel it. I'm still having to wear pants that are loose in the waist as my abdominal scar is still tender. Too many of my pants (which have been made to fit low in the waist) hit that scar, so I'm still debating how to handle it for Norway.

Two weeks post-surgery, I started taking Tykerb again and my face broke out - all over my chin and around my nose. Sigh. So, I went off it for a few days and then tried again and it broke out all over again. I went off it for a week and it cleared up. I also noticed that when I was off Tykerb I slept soo much better. I started it again on Sunday - my face is still clear, but my sleep has been disturbed and my hot flashes have been worse.

I'm debating about whether or not I should continue taking Tykerb. I know what my doc might say. My thinking is that I am doing pretty well at the moment, with low tumor markers and decent energy. Wouldn't it be better to go off it and if (and I think it's a big IF) I had a relapse, then I could go on it again and it would be more effective? When I mentioned this reasoning to my colleague, his reply was that while that might work for antiobiotics, Tykerb works differently. The belief is that Tykerb is keeping everything under control and that if I discontinue, the cancer will come back with a vengeance.

So, I started it again. I also painted my bedroom (pics will be posted sometime), and even one week later, I still got headaches. That reminded me of my carcinogenic mattress (I believe that that chemical pillowtop mattress caused my cancer to mutate and then spread to my bones and my skin), so I thought that it would be nice to have the extra insurance of the Tykerb.

But yesterday, after talking to my acupuncturist, I think that I may stay off Tykerb and not tell my oncologist and just see what happens. After all, I was off it for a month and my markers were fine. I just think that my body might be better able to fight any cancer better if I can get a good night's sleep. In other words, I think that Tykerb helps keep cancer in check, but at the cost of my sleep. Now that I'm getting stronger and rebuilding my immune system (from a Chinese medicine perspective), sleep might serve me better than Tykerb. In other words, maybe Tykerb is creating a vicious cycle in which it interrupts my sleep (waking every two hours and then having more hotflashes at night), so my body is not able to heal itself and fight off cancer, thus creating the need for more Tykerb.

I also figure that I've done or am doing lots of other things that help my body fight cancer. First, I had my ovaries removed and both of my breast cancers were estrogen positive. I also take a five-mushroom blend in pill form - three of them have been scientifically proven to be effective against cancer. I also take melatonin and as I mentioned in an earlier post, melatonin has been effective against tumor cells in mice. One of the student groups looked at light pollution and how there seems to be a correlation with cancer - they also mention that blind women have lower than average rates of breast cancer. These women don't perceive light and so their bodies are able to produce the melatonin they need for a good night's sleep. I also take turmeric which has been found to be antiinflammatory as well as effective against melanoma, a skin cancer. Turmeric helps with things like arthritis. I don't feel any ill effects from any of those herbs and I sleep better. And, I practice qi gong, still, which helps keep me centered and calm, not stressed out. That helps my immune system. As does coloring mandalas.

I've also been reading a book by Andrew Weil entitled "Spontaneous Healing". He states that by the time cancer has developed in a person's body, it means that that person's immune system has broken down. He's a proponent for doing things that build up the immune system again. Getting a good night's sleep is an important part of building one's immune system. Western medicine tends to clobber disease and illness over the head, but as it's doing that, it's clobbering the immune system as well. It's a fine balance.

So, I'm gonna experiment. It's my body, after all. I figure that I get monthly checks of my tumor markers and if they start creeping up, then it's back to Tykerb. I promise.

Eddie and I are both on the mend

Eddie went to school today. He's feeling much better and has an appetite again. Yay!

As for me, I'm doing well, too. My energy and stamina seem back to normal and my incisions are healing nicely. I can feel a little bit of tightness around the right breast area. But I can almost lift myself to sitting from laying down without using my arms and more of the stomach. I still have a bit of discomfort around the belt line when the waist of my pants hit it. I'm gradually trying to stretch the abdomen where they released the TRAM. I can pretty much stand up straight.

Work is busy. But pleasantly so.

I don't have any complaints.

I like saying that!

Introducing . . . my new strapless camisole by Spanx!

Since my surgery, my plastic surgeon wanted me to wear an abdominal binder to help support the abdomen, especially the TRAM. But when I saw him last Monday, he said that if I could find a girdle or some other garment that would help support my stomach, that I could switch it since the binder is so bulky. I finally had a chance to look for such a garment on Thursday and I found a strapless camisole from a company called "Spanx"!

Apparently, they started as footless tights, that help do away with pantylines. And, the owner, Sara Blakeley, after finding someone to manufacture the product, hit on the name "Spanks" and then switched it to "Spanx". She says that: "Spanx is edgy, fun, extremely catchy, and for a moment it makes your mind wander (admit it). Plus it's all about making women's butts look better, so why not?"

Okay, yes, I was wondering what the name might refer to!

Anyway, the one I have is black and I double it up - I don't think that I should put anything tight around my breast area yet. It sure is more comfortable than the binder and it does give me the support I need.

I'm standing up straighter, although still not quite upright. I've been doing most household chores, keeping what I lift fairly light still. I have more energy every day. The way I see it, it's all uphill from here.

The only bummer is that I started taking Tykerb again last Sunday . . . and darn-it-all, my face is breaking out all over again! It was nice and clear for a few weeks. Sigh! Well, as my friend, Tammy, reminded me, better to have a few zits than the alternative. Eyes on the prize, eh?

Back to Work

Today was my first day back at work . . . and I survived! I am a little bit tired, but I was able to walk from my son's school to my office without too much trouble. I'm starting to stand up straighter.

I also saw my plastic surgeon, Dr. H., today. He took the tape off the stitches and now I should be able to sleep without having to sit propped up. I can already feel my abdomen getting a bit stronger when sitting up.

So, I'm on the mend. Yay! I even got an interview in today on one of my projects! And, I'm gonna go watch my v-ball team play tonight. I got to cheer them on even if I can't play!

Doing Well

One week post-surgery, I'd have to say that I'm doing pretty well. I don't have a lot of pain. I figured out why I had continued to feel light-headed and couldn't read - my eyes were dilated for a few days after taking off the Scopalamine patch!! The patch can also cause dizziness. This patch is often used for motion sickness and I wore one for three days.

I think my eyes are back to normal and I don't feel light-headed any longer. Yay!

I still have some discomfort in my abdominal area, but only when I cough. I have to be careful about how I stand up from sitting or how I sit from standing, but overall, I'd have to say it's been fairly easy.

I was pretty tired yesterday, though, feeling really lazy. Just watched some movies. I did a bit of work on my taxes. I hadn't slept well the night before. Dr. H says that while I'm healing, my body has a lot of metabolic demands. I need to take in a lot of calories. No problem there!

I slept okay last night, though. I have an appointment with Dr. H today - I will probably get the drains out and will be released to drive. Yay!

I'm home!

I stopped taking narcotics and antinausea meds in the hospital in the middle of the night Saturday night. By late afternoon on Sunday, I was able to finally eat a turkey sandwich (my mouth felt like cotton). Once I was able to eat solid foods, Dr. H discharged me, so I came home this morning! Yay!

I do have some pain - but really minor (a 1 out of 10), more like a discomfort that Liz talked about. I really don't even feel much of the pain until I cough and I seem to be coughing quite a bit from a build-up of fluids in my lungs.

But, I have boobs! Yay!

And, Dr. C took out my ovaries. While she had the camera looking at my insides, she took pictures of my liver, my gall bladder, my uterus and fallopian tubes in addition to the ovaries. The good news? There's nothing on the liver. It looks whole and pink and healthy. No lesions. Great news - means that the cancer has not spread there. So, as far as we know, it's only in the bone marrow.

Dr. H also excised the bad radiated tissue where the wound was (no more open skin wound!) and they sent it to the lab to test for cancer. I don't expect the lab to find any. I'll keep you all posted.

Otherwise, I'm trying to keep a low profile - need to figure out a comfortable spot on the couch.

Whew. Glad it's over and done with. Now, on to the healing!

Prepping for New Boobs

The surgery for my TRAM flap, insertion of an implant, and the oophorectomy (removal of my ovaries) is now 17 days away. But who's counting, eh?

I met with my plastic surgeon yesterday for my pre-op appointment. He showed me graphic pictures of the process, which was a bit daunting, but now I can visualize it better. I am trying to talk to those tissues so that the shock of the incision won't be as bad. My acupuncturist said today that it was good to prepare my wei chi (I think that's spelled right) or the fighting chi for the surgery so that maybe it won't react by fighting but will go along with the process and begin healing. In other words, by visualizing the surgery and preparing my tissues for it, I'm hoping that instead of reacting with fear and anger at the insult, it accepts the surgery as something needed and then does what it needs to do for healing. Does that make sense?

I'm starting to get anxious about the surgery. My acupuncturist asked me if I was worried and I had to say that I wasn't really worried, but more apprehensive about feeling the nausea after the anesthesia and the painkiller narcotics and also about the pain. She gave me tips for the nausea (magnets on pericardium 6 - near the wrists and also ginger tea) and then said that there were some herbal remedies for the pain if I needed them. She also gave me a movement from the Thousand Hands Buddha form that will help calm the anxiety. I will see her about 10 days post-op and she said that she'd do what she could for me at that point.

I also talked with Dr. H (the plastic surgeon) about saying positive things during surgery - his staff read the excerpt from Bernie Siegel's book "Love Medicine and Miracles" about giving instructions to patients while they are under anesthesia and thought it was cool, so I'm hoping they reinforce what the reading said to him. He has agreed to say positive things. I also mentioned it to one of my friends, Lynn, who is a surgical nurse at the hospital. I asked her to tell her coworkers about this. She seemed really interested and wanted to read the excerpt. She says if it makes a difference, maybe it's a practice they can implement during surgeries all the time. I would love it if this is something that would make a difference in peoples' lives!!

I asked Dr. H what music they listened to while they perform surgery and he stated rock/pop. I plan to call his office tomorrow and ask if I can give them some music CD's to use during my surgery. I hope so. I spent some time this evening putting together mixes entitled "New Boob Tunes" and "Dee's Boob Tunes"!! I chose my favorite songs, including some with positive messages and songs that have lots of good, fun energy and also some with a bit of fight in them - a bit of attitude, and a couple Native American/Alaska Native songs. I hope they use them! If any of you have suggestions for songs like that, I'd love to hear them!

I also saw the wound care nurse, L., for the last time. I will miss her. I need to bring or send her a thank you card.

Tomorrow, I will get some blood work done in preparation for the surgery.

Whew. I've got lots to do at work beforehand. I am also trying to remember what my fellow breast cancer survivor told me last week: 1) getting her TRAM flap was absolutely transformative for her (i.e., which means that I should focus on the positive); and 2) that as bad as the pain is at the moment, it will be less the next day. So, I keep thinking that one thing that will be good is that I will no longer have an open skin wound. The other thing is that it will be the first time in 14-15 months when my shirts fit correctly!

Update with the plastic surgeon

I saw Dr. H yesterday and told him about my phone call from Dr. K about surgery. Dr. H assured me that he felt it would be okay to do the reconstruction surgery and my memory that bringing in good healthy tissue with its own blood supply might actually improve circulation on the right radiated side. He also said that there would not be an open wound any longer (YAY!) and that any wound that needed to heal would be underneath the skin. He did warn me about potential complications but I didn't ask for details - my thinking is that, in this case, the power of suggestion might influence my recovery and I'd rather not know and expect the best instead. He said that he'd talk to Dr. K and try to get to the bottom of his concerns. Dr. H said that if I were a different kind of patient, one that's struggled more, then he'd really listen to Dr. K's concern, but instead, he sees me as a young, relatively healthy patient with fortitude (I think is what he said) and felt that because of my attitude, I should do fine.

For some reason, last week in Vegas, I remembered a passage from Bernie Siegel's book "Love, Medicine and Miracles" in which he related several anecdotes about the power of suggestion while patients were under general anesthesia. There have been several studies that have shown that while patients have their eyes closed and they don't remember anything while they are under, they hear everything. In one case, a surgeon said a lot of negative things about a patient while she was under and she woke up crying and cold. So, Bernie stated that he started to give positive statements to patients - even saying things like, "you will wake up hungry, thirsty, and pain-free" and patients generally do a lot better post-operatively. So, I copied a few pages from the book and gave them to Dr. H yesterday and asked him if he would say positive things while I was under and he said that he would certainly be happy to do so.

He also said that I should certainly say something to the anesthesiologist prior to surgery about what happened to me and to see if there is anything else he or she can do to alleviate some of those side effects.

All in all, it was a good appointment. And, I got "pumped up" even more on the left side. It's finally looking around the same size that I was prior to the mastectomy.

It'll be nice to look normal!

Cat News . . . and a Phone Call From My Oncologist

I took my cat, Elizabeth, to an orthopedic surgeon vet, today. He couldn't see a tear in the muscle on the x-rays and he felt her leg and definitely found the area that hurts her - it was still swollen. It wasn't the achilles, but another muscle that corresponds to the area of our calf muscle - forgot the name, it was "gastro" something or other. He said that he'd never seen an injury like this before, but it was his opinion that we should wait and see if the injury heals itself. If it isn't better in a couple of weeks, then we might talk about surgery. He based part of his opinion on the fact that she does appear to be better. She's not dragging her foot (the foot would actually bend so that the top of the foot was dragging on the ground) like she was and she is now able to gingerly put some weight on it. I just saw her hop on top of the chair - technically, I'm supposed to keep her from jumping so that she doesn't reinjure that muscle. But I couldn't get to her in time. So, it does seem to be resolving itself and she really wants to go outside.

Whew. It saves me some money.

In other news, after dinner, I got a phone call from Dr. K, my oncologist. He said that he's been getting updates from Dr. H, my plastic surgeon, about my upcoming surgery. Dr. K just wanted to go on record as saying that he thinks it's a bad idea and that it might take a few months for the tissue to heal (since it's been irradiated) and that it'd be better to leave well enough alone. However, as Dr. K said, he is not a surgeon. My understanding from Dr. H is that this kind of reconstruction is actually going to be a good thing because he's bringing in good tissue with its own blood supply - and it's also tissue that's never been radiated - and so I don't think that the wound would take as long to heal.

So, now Dr. K has me questioning the whole thing to some extent. I will proceed with the surgery but will make sure that I broach the whole topic with Dr. H first to make sure my understanding is correct. I asked Dr. K if his concern was with whether or not I'd have a relapse and he said that it wasn't. He was more concerned about having a wound that would take months to heal, especially since I've been dealing with an open skin wound for 9 months already. Granted, it has been almost five months since the tissue expander came out and it's not quite healed yet ... in the end, I don't really think that any one really knows what will happen. My case is somewhat unique. Honestly, I'm more concerned with the potential of a relapse - I know I can deal with an open wound. But it wouldn't be an open wound - it'd have sutures. Sigh . . .

It's always something.

Pump Up the Jam

I saw my plastic surgeon today. He thought the wound was healing nicely - he even saw some good skin tissue in the area that he was concerned about last month. I told him that I'd pretty much decided on a TRAM flap and he was fine with that. I also asked about whether or not the left tissue expander needed "pumped up" and he had time today, so he put another 50 cc in that side. So, I'm even more lopsided. I think I can see the difference and I can feel a bit of a difference, too. I said that I wanted to get to about a "B" cup. He didn't seem to know how much total saline that would take. I think I have about 400 cc's in that side now. I guess I need to measure it . . .

He's gone for the next couple of weeks, but after New Year's, I have two more "pump-ups" scheduled.

This is certainly a strange process, eh?

Besides, I get a tummy tuck . . .

I just did a bit of reading online about the TRAM versus the lat flaps. An added benefit of the TRAM is a tummy tuck. Don't think I need a shoulder blade tuck. And, I do like to play v-ball and tennis and the lat flap might interfere with those activities.

Can you tell? Still leaning toward the TRAM.

For pictures of a TRAM flap, you can go here - see Figures 12, 13, and 14. Not for the squeamish, though. I was a bit uncomfortable looking at it!

A Date for New Boobs!!

Met with my plastic surgeon, Dr. H, today. The result? I will get my Christmas wish for reconstruction, just not in time for Christmas.

Turns out that Dr. H is already booked up into February. He's going away for two weeks over the holidays for family time. Can't begrudge him that.

So, while disappointed, I'm really okay with waiting. It allows me time to do my homework and then make appropriate arrangements for a wide variety of things, including work, child care, house stuff, coordinating doctors, etc.

And, oh yeah. You all might want the date, huh? It's February 6th. I still need to talk to my chair, but I think it'll be okay since I chatted with him about it briefly last week.

February 6, 2009, is about 80 days away.

It's still up in the air as to what kind of flap procedure I will have. To reiterate, I will have an implant on the left side, but a flap procedure on the right since that side has now been radiated twice and the tissue is too damaged for an implant.

The two flap procedures we could do are a TRAM flap and a Lat flap. The TRAM takes tummy fat and uses some of your abdominal muscles. They cut away this tissue and then bring it up, under the skin, to the breast area. This way, they keep all the blood supply intact. (I could go to New Orleans for a free flap procedure, but I really don't want to be that far away from my support system. With a free flap, they cut the tissue completely away from your body, reattach it and the surgeons spend hours reattaching the blood vessels.)

The Lat flap takes muscle from around your shoulder blade area - the latisimus dorsi muscle - and they bring it around under your arm, under the skin and other tissue to the breast area. However, since there isn't a lot of tissue to use, it means that I would also have to have a smallish implant there in order to even things out.

Other considerations:

Both procedures have the net effect of weakening those muscles - whether they be in your abdomen or in your shoulder blade area. The Lat flap would make it difficult for things like swimming or cross country skiing. I think with the abdomen, there's just long-term issues regarding lifting and back issues, but I need to check into that.

Pros and Cons:
With the TRAM flap, there would probably be no need for an additional surgery other than adding nipples and tattooing. There's always a chance, but probably not. In the long term, I could probably much continue with all my activities eventually. Also, since there will be no implant, there is less risk of infection stemming from a foreign object. The wound more than likely has bacteria and an implant would exacerbate risks of infection.

Cons with a TRAM flap are that the recovery time after surgery is longer - probably at least three weeks. There's more discomfort. Fat also has less blood flow than muscle.

With the Lat flap, there is more blood flow to the area, which is generally seen as a good thing but now I can't remember why. There is less recovery time after surgery (2 weeks) and less discomfort.

Cons with a Lat flap is that we'd have to put in a tissue expander - again - and then do another surgery to put in the permanent implant. Then, there's the nipples and tattooing. The tissue expander/implant increases the risk of infection to that area.

I think I'm leaning toward the TRAM flap. Get it all over and done with as it is unlikely that I'd need another surgery. I'd rather have more discomfort at once then have to potentially go under the knife again at some future date - and also go through the whole tissue expander thing again which is uncomfortable.

I'd also be able to do an oophorectomy at the same time.

Decisions decisions. But I've got 80 days beforehand to think about things. The wound, and whether it continues to heal or whatever, may dictate the course of action, too.

80 days and counting!

Appointment Schedule with Dr. H

An appointment with Dr. H has been scheduled for Nov 18, 8:45am. More news about reconstruction surgery should be forthcoming after that appointment.

Now that I've been given the green light to go ahead, I just want to get it done. I'm tired of having this tissue expander in my chest. I want to look normal again .. .

I'm both excited and apprehensive. I don't particularly like surgery. On the other hand, surgery is inevitable since I have this expander and I also need the oophorectomy (ovary removal), so I might as well go forward with it.

Yippee!

All I want for Christmas is My Two Front . . .

Boobs!

What does this mean, you ask? Well, good news from my oncologist, Dr. K.: there is nothing going on with the rib bone. He said the radiologist said that the bone looked okay. Cool.

I then asked if he'd talked to Dr. H, the plastic surgeon, about the timing for reconstruction. He said they had talked and Dr. H was inclined to wait until spring break in March in order to give the wound more time to heal. But then I told Dr. K that the International Arctic Science Committee asked me to co-chair a session related to Indigenous Cultures - Past to Future for the Arctic Science Summit Week in Bergen, Norway over spring break. I'd like to go to that so March would be out and my chair would prefer that I try to schedule a surgery around winter term teaching, which means scheduling it for maybe the second week of December. Dr. K was fine with that and he said I'd just have to convince Dr. H that that was okay.

So, yep, it looks like I might be getting what I want for Christmas!!

What's Next for the Wound

First, Dr. K (my main oncologist) and Dr. M (the rad onc) looked at the wound. Overall, they thought it looked fairly well - they were both expecting something a lot worse, but they thought it looked a lot better than when the tissue expander first came out. Dr. M thinks it is highly unlikely that there's anything going on with the bone. Dr. K is inclined to stay the course - that is, just continue monitoring the wound and making sure that it continues to heal. He is going to order a CT scan of just that bone just to make sure nothing is going on. If the healing of the wound plateaus, then we may consider the hyberbaric oxygen treatment or surgery.

Regarding surgery, Dr. K believes that it would be okay for me to have it. He's going to look into whether or not I'd have to go off of Xeloda and Tykerb and if so, then it might only be for a couple of weeks prior to surgery. He doesn't think the risk of recurrence would be too much.

I mentioned that I still have a tissue expander on the left side, which has a metal-backed port, and that I'd like to get it out of my chest. So, that means surgery at some point and if I have to do surgery, then I might as well do reconstruction on the right side. Dr. K agreed - when he said that I couldn't have reconstruction "in your lifetime", he was referring to an implant, but has no qualms about the flap procedure. So, reconstruction is back on the table. And, if I do reconstruction, then they might bring in tissue to protect the bone, if it's needed.

As I understand it, here's the plan of action:

1) In order to encourage the wound to heal more quickly, I start taking Vitamin E and also something called Trental. Trental causes the blood to become less viscous - i.e., it allows red blood cells to go through restricted blood vessels better so that they can bring more oxygen to the wound. Possible side effects include dizziness and nausea. But most tolerate it fairly well. And, I continue with the dressing changes and periodic visits with the wound care nurse, L.

2) I will have another CT scan just to see if anything is going on with the rib bone. If there is something, then perhaps we consider hyperbaric oxygen treatment or surgery.

3) We put reconstruction back on the table. Dr. K will talk with Dr. H (the plastic surgeon) about the timing of this surgery. It may be as early as December or not until March, to work around my teaching schedule.

Sigh . . . Why can't I ever be a simple case?

I need to fix my son dinner, so I will try to make this short.

I met with my plastic surgeon today to talk about reconstruction options and also so he can look at the wound.

FACT: The deeper open wound where the tissue expander popped through in August is still healing (I think) but it is very shallow. There is no soft tissue, other than this white plaque/scab, over the rib bone there.

FACT: I am still on an oral chemotherapy (Xeloda) regimen as well as Tykerb, Zometa, and Zoldex.

FACT: I am no longer a candidate for an implant on the right side as that tissue is too damaged after being radiated twice.

FACT: Surgeons don't like to do surgery on people who are immunosuppressed, i.e., people who are on any form of chemotherapy.

FACT: I have attained a "stable" status in terms of my cancer.

UNKNOWN: Whether or not I can have reconstruction on the right side.

UNKNOWN: The possibility exists that there is an infection in that rib bone that only has this scab over it. If I understand Dr. H correctly, if there is some sort of infection there, then that might keep that whole area from really healing. However, I do not have a fever and I do not have any other symptoms of an infection. The wound looks good and clean.

NEXT STEPS: An x-ray and/or some kind of scan to determine whether or not there is an infection in that rib bone. If so, I may require surgery to take out that bone in order to allow the rest of the bone and the tissue to heal. If I do have surgery, then Dr. H would do a lat flap (latisimus dorsi) flap procedure in order to bring in some soft tissue to cover the bone so it can heal. I may then also be able to have some small breast reconstruction on that side. I may have to go off of chemotherapy prior to surgery, but my question is whether or not that means all four of those drugs (Xeloda, Tykerb, Zometa, Zoladex) or just Xeloda. Xeloda is the only true chemotherapy drug I take. Tykerb is a targeted therapy, Zometa strengthens my bone, and Zoladex shuts down my ovary production. Maybe, just maybe, I only have to go off of Xeloda.

NEXT STEPS, Part 2: Keep monitoring the open wound. About half of the wound is healing. The half that is slower to heal is where the tissue expander poked through. If the wound plateaus and doesn't heal, then we look at surgery so that it can heal otherwise I risk getting a bone infection and I have to go off of chemo. If it does heal and if Dr. K (my oncologist) says it's okay for me to go off of chemo, then I may be able to have reconstruction.

So, it's a wait and see game. It never occurred to me that I could get a bone infection! I don't have any symptoms, but more than likely, there is some bacteria in that wound. It's not infected (we don't think) because I don't have a fever or have any other symptoms. The dressings I use there have antimicrobial properties which help keep things from getting infected. But if no soft tissue ever grows there, I run the chance of getting an infection since there is only a really thin superficial scab-like thing over the bone.

Dr. H, the plastic surgeon, isn't quite sure what to do with me as he hasn't had a patient who is taking oral chemotherapy. He and Dr. K have to talk. Dr. K was of the opinion that I couldn't have reconstruction but the reason he gave me was because of the damaged tissue in that area due to radiation. But Dr. H thought that it may also be due to having to go off of chemo.

Confused? I was, but I think I have my story straight. It's complicated. Why can't I/my body take the easy/simple solution?

Sigh . . .

It was a beautiful day out there today - probably in the mid-70s. I am relatively rested from my trip. I'm generally in a good mood. There is much that I'm thankful for! Thanks for your continued support everyone!

Booblessness and Reconstruction

As my faithful readers, friends, family, and colleagues know, I lost the tissue expander on the right, radiated side about six or seven weeks ago. It was somewhat traumatic, but I got through it. Now, however, I am completely flat on the right side and "flat" may be a optimistic at best - sunken in is more like it.

I'm still getting used to it and I feel it's pretty noticeable. After all, before that, I had at least the semblance of breasts. There was a small mound on the right side with the tissue expander and an even bigger mound on the left side (between an A and a B cup there). However, being "boobless", I've found myself buying blousy, loose shirts these past few weeks to disguise the flatness. (Granted, it was partly an excuse to buy new clothes!) Finding these styles of shirts is hard, you know, because a lot of the styles now are tight, form-fitting, low-cut, tailored kinds of shirts. Luckily, the stores are selling peasant-style blouses, too.

This morning, though, I decided (after putting on another new shirt that wasn't as loose as I thought) that I was spending too much mental energy (not to mention money) into disguising the flatness. Everyone I know and care about knows that I am flat. I decided that I needed not to care what strangers think anymore. (Which goes to show you just how fixated our society is on image - I was buying into the whole thing, but that's a post for another time.) Soooo . . . I'm going to stop worrying about it.

I do plan to have reconstruction at some time in the future. . . I just want to feel and look normal in my clothes. But until then? Who cares what people think, right?

Hey, is "booblessness" a word? : )

Healing Nicely

I saw the wound care nurse today and she was pleased at how well the wound is healing! I now have a "peninsula" of good tissue, starting from the top and extending down to almost the bottom part of the wound. This peninsula kinda cuts the whole wound in half. The total area is about 8 cm by 2 to 2.5cm, but the edges are encroaching on both sides and then there's a 2x2cm peninsula right in the middle. Yay, oompa loompas!

This makes me realize the extent to which the cancer in the skin was keeping the original wound from healing. By the time I started radiation, I'd had the wound for about 2 1/2 months with no real improvement. Then, radiation kept the wound from healing. Then, there was the whole episode with the loss of the tissue expander and the open cavity (the Bat Cave). The wound pump came off on Aug 22. Now, about five weeks later, there is already much improvement. Maybe in another month or six weeks, I won't have to wear a dressing anymore.

How cool would that be?

I bumped into another survivor today and she is undergoing reconstruction. She mentioned that she just started the tattooing process (on the nipple area) and she reported just how different it was making her feel. She spent some time a few weeks ago wondering why she was undergoing this whole process - all the appointments taking time out of her day. Now, she knows. She says it's totally worth it.

Now, I'm more determined than ever to do all of that myself. Soon enough. Time to think about that later. For now, I'm happy just healing and regaining my strength and energy.

Please send some of that healing energy to my friend and fellow blogger, Teri, the Cheeky Librarian. She's doing what she calls the "scan dance" and may soon have a biopsy on her liver. Another fellow blogger, Liz Kreger, has just finished radiation for a tumor on her brain stem. She seems in good spirits. NYC Jeanne, at "Rock the Bald", will soon start radiation and I believe her hair is growing back post-chemo. She needs some healing energy, too.

Thank you to everyone who is helping me. I do appreciate it. I am buoyed by all of your support!

Hmm . . . Still Pondering That Conversation

Today, I had a check-up with my oncologist. It started out fairly well - every time I see him, they ask me to fill out a form about any medical issues/side effects I may be having. I sat there and thought, hmm, I don't really have any, other than the healing wound and lymphedema. (Got a f#*@in' bee sting yesterday that's sorta making my knee stiff - it's right below my knee - and I want to scratch it!) I've been getting hot flashes, but not too badly. My sleep has been really good this past week or so - I've been sleeping at least 3-hour stretches the past few nights. I have energy. I just have a bit of pain where the lymphedema is, but it's intermittent. So, I wrote on the form, "Hey! It's nice to just have 'normal' problems!" The nurse and my onc chuckled at that.

He looked at the wound and the area that was radiated and he didn't see any signs of cancer and neither did he feel any lumps. Cool.

Then, we looked at my CT scan. I asked him what he meant by some spots being somewhat bigger and how that was related to the healing process. He said that the body is trying to seal off and contain these small colonies of cancer cells that are in my bone marrow, so it takes calcium out of the serum - the circulatory system- and surrounds it with a layer of calcium. Sometimes, cancer pokes out of the calcium shell and starts growing. It didn't look like that was happening in my body as he just saw the calcium spots. So, when a spot does get bigger, sometimes it means that the body is adding another calcium layer on top of what's there.

Zometa makes my bones themselves stronger. By making it stronger, it makes it harder for cancer to lodge in the bone itself. He likened it to a worm going through sandstone versus a worm trying to make a hole in granite. Zometa makes my bones more like granite. Cool. I have no cancer on the bone itself and we want to keep it that way.

I wondered if, in the healing, the body was leaching calcium out of my bones and that made them weaker and he said that that wasn't the case. It's taking calcium out of the serum in the bone marrow. Both cancer and cancer treatments can make bones weaker. But Zometa will take care of that.

I asked about whether or not those calcium deposits (now surrounding dead tumors- at least that's what I think) in my marrow would ever disappear. In his opinion, he feels that they are likely to never go away. Sometimes, the body dissolves those calcium deposits. But not very often.

Bummer. I'd hoped that those buggers would go away. I will continue with my visualization to get rid of them.

I then asked about when someone is considered to be in remission. He said that there are different definitions of remission. The first is when there is no progression of disease, that a plateau of sorts has been reached so that there are no new spots and whatever spots there are aren't getting bigger. That's where I'm at. The second definition is when all the tests show "no evidence of disease". He doesn't feel that I will ever be in that category.

Hmm. Guess I'll have to prove him wrong.

Then, on my way out, I asked about reconstruction surgery. His reply was, "not in your lifetime". (What? That was a surprise to me.) He just didn't think the skin and tissue there would ever be able to handle a surgery like that. At least, that's what I gathered. I told him that my plastic surgeon thought that he could do reconstruction. So, my oncologist said that he'd defer to the surgeon on this one. At the very least, we'd have to be sure that there was no disease left there in the skin before considering surgery.

Okay. That calls for another consultation with the surgeon. I will wait until this wound heals and then schedule that appointment. And give the whole area a few months to be sure that nothing returns in the skin.

Hmm. Guess I'll have to prove my oncologist wrong, again.

Overall, he did say that he was pleased that we'd achieved stable. He seems satisfied with that. But, I'm going for NED. And, reconstruction. Never say never, right?