On the road to recovery

The surgery to remove the chest tumor was yesterday.

The good news is that the surgeon said there was a "plane" of good tissue under the tumor and that cancer was not in the sternum. The other good news is that he was able to pull enough good tissue (I think the TRAM flap from reconstruction) so that the skin graft is only about 3cm in circumference. He thought it would be a lot bigger.

So good news all around. However, the nausea stayed with me until partway through the night. It is a lot better now. Not sure if I will be discharged today or tomorrow although right now, I am already readynto go home. Sometimes talking to strangers about my problems and history is just too exhausting.

Hmm, I think I will change my own dressing in my armpit. The nurses here are busy. I will finish my jello first and then get it all ready.

Thank you all again for your continued support!

I Convinced the Surgeon . . .

and surgery to remove the chest tumor will occur next Thurs June 23. The surgery should only take 1-1.5 hours. I think I'm only in for an overnight stay.

So, here are my reasons:

1) Herceptin, while maybe slowing the growth of that tumor, is not shrinking it either.

2) Because I am due to start whole brain radiation in late June/early July, the earliest I would add a traditional chemotherapy (which MIGHT shrink the tumor) would be late July/early August. In the meantime, the damn thing would continue to grow in small increments.

3) We don't know for sure that chemo will shrink the tumor. If the wound in my armpit is any indication, it might shrink it temporarily (and remember that was helped along by the immunotherapy I received) but then it grew again. By the time I finally got into surgery for the armpit, the damn thing was 15x12cm large. So, if we wait to do chemo for two months, that puts me into late September. That means this tumor would have 3+ months to grow. I think it's grown maybe 0.5 to 1cm in one month. It could potentially be 3cm larger by the time we decide that chemo hasn't worked. So, I'd end up with a much larger wound than I would have now.

4) I don't have any faith that chemotherapy will actually shrink the tumor. I think going on Abraxane, while temporarily helping, damaged my immune cells (those Herminator t-cells) too much, subsequently allowing the armpit tumor and the brain tumors to grow. I still am not sure if my immune system is fully recovered from it. I have more faith in my own immune system to fight this thing, so I want to do what I can to support my own immune system. I once read part of a book that discussed statistics associated with chemo and I ended up thinking that while you might read something like 33% of patients improved (or whatever the statistic), it said that you needed to look at the actually study - and some studies have small numbers of patients, like 10 or 20. I also know other metastatic breast cancer bloggers who have tried all sorts of chemo cocktails, only to have their cancer progress. I don't want to get caught in that trap. It's not that I won't do chemo if I have to - I will. But at the moment, I won't start a traditional chemo regimen for 6-8 weeks. I will only have targeted therapies.

5) So, it seems that now is the time to strike at the chest tumor, which started growing around February (I think). Nip it in the bud. The surgeon knows he won't get clean margins (as did the surgeon up in Portland). So, there will still be some cancer left deeper, like near the bone. But, to me, it seems that if we get rid of the bulk of the tumor now, then chemo might be more effective later, as there will be less cancer cells to deal with. At the moment, it's about 6x5cm. Something like that.

6) The surgeon, Dr. F., felt that it was more movable than it was the last time he felt it.

7) Dr. F. did warn me that I might end up with a bigger wound than I have there now. I reminded him that I had a large wound there for 11 months before reconstructive surgery with the TRAM flap - at that point, it was maybe 12x8 cm? I also said that I dealt with a really large wound in my armpit for months before the April 1 surgery - and even afterwards. But I also said that the wound care nurse said that the fact that the armpit is healing, slowly, but it's healing, is a good indication that this wound might eventually heal. It'll heal better with less cancer there, that's for sure.

8) That area has had radiation twice, so that is NOT an option. And, the tissue in that area has been compromised due to surgery and radiation, so chemotherapies are not as effective as they might be with healthy tissue. That's another reason why I don't think chemo will do the trick with this large a tumor.

I don't want to wait months only to see it grow like I did with the armpit tumor. So, he's agreed to do it. I hope that it is the right decision. But I figure I'd rather have an open wound with a depression in my chest than an open wound with a 2cm protusion. There will be less cancer there, which will help chemo keep things at bay and which will allow healing.

I really want to get rid of this unicorn boob!

Limits

I am finding what my limits are, in terms of pain and levels of activity. I was dismayed and discouraged yesterday afternoon and evening because I got so uncomfortable and tired and tense after a friend came to visit.

I am trying to wean myself off of Dilaudid - Thursday into Friday, I took only one 2-mg dilaudid every 8 or 9 hours. I was fine as long as I stayed home and either sat in my chair or my bed with strategically placed pillows.

But yesterday, I went to wound care and about an hour later, a friend came to visit. Around the time of her visit, it was time for Tylenol - and I ended up taking a dose of dilaudid a few minutes after she left. My friend and I sat at the kitchen table, but I couldn't get my arm comfortable. My back - where they took the lat flap - was achey. My breastbone (sternum) feels pressure. And, where the drain comes out, around my ribs, bothered me. My shoulders were tense. I was restless because all I could think of as we visited was how uncomfortable I was. I couldn't wait to get horizontal in my bed.

Granted, before that, I hadn't been in bed since about 7:30 that morning. I sat in a chair in the living room, cleaned up, then went to wound care, then sat in the chair some more. I think that may be progress.

So, I took dilaudid and laid down and napped off and on all evening.

I was worried last night because I realized that if I can't sit at the table for long - or stand - I won't be able to teach next week. I still find it hard to concentrate for long on any paperwork. I don't know how I'm going to grade papers. It's hard for me to concentrate on what I'm going to say.

I tire easily. An hour with the wound care nurse and about 45 minutes with my friend wiped me out. How can I handle an almost two-hour class? I was also running a low-grade fever (99.4 - 100) last night.

In retrospect, I probably should not have taught our department's 4-credit class. I can probably handle the Honors College class (one-credit) that I'm co-teaching with a colleague. I will probably cancel all other appointments next week except for wound care.

So, recovery is still slow. I guess, when I think about it, it is not unexpected. I was anemic before surgery. They gave me two units during surgery, but my hemoglobin was 7.5 when I came home. It's been hard to retain nutrients - I am on a stool softener because of the dilaudid, but not all my food is digested; then the new antibiotic gave me diarrhea. My appetite is fantastic - I eat a lot. I'm also eating more yogurt to help with digestion. But my body is trying to fight off infections, build new skin and tissue, and fight pain/discomfort.

The good news is that the wound is healing. L., the nurse, took off some dead tissue. The honey dressing really helped with the odor. There is less drainage - from about 90 ml in 24 hours to 60ml yesterday. L. could see good pink tissue under the dead tissue. She was happy with it.

My plan is to take Dilaudid more often (i.e., every 4 or 5 hours, maybe 6), lay down more, rest. I'll see how I feel on Monday. But I tend to think that I may have to talk to my boss about this class . . .

COUNTDOWN - 10.5 hours . . .

and only one more dressing change!

YIPPEE!

I will have drains in for about 10 days (a major pain in the neck, but it goes with the territory). I will also have a catheter delivering a local anesthetic to the donor site (my lower left shoulder blade) for awhile. This will help me go off any pain meds sooner. I will also have a skin graft taken from my left thigh. So, I will likely be uncomfortable, but I know it gets better every day and that's a whole lot better than pain getting worse as it is now.

I'll see (i.e., well, you'll see my words) you all on the flip side!

CT Scan this am

cT scans take a lot out of me. Not sure if it is the iodine contrast, the fact that I don't get breakfast until afterwards, or maybe I just didn't sleep well. I need to take it easy this pm.

Anyway, I will need to see if I can schedule appointments with Dr. K after a CT scan more often. He pulled it up as soon as I told him I had it. The good news ismthat it seems like the blood supply to the latisimus muscle does NOT have cancer involvement, so I will get the easier pedicle flap, which means the blood supply is still attached to the flap with reconstruction. It is a shorter surgery and a faster recovery time!

It was hard, though, to keep my left arm above my head because of the pain. I just tried to deep breath through the pain and when I felt myself stiffening up with the pain, I just tried to relax arm and shoulder muscles.

The other spots of cancer (sclerotic or scarred lesions - where there are calcium layers around clusters of cancer cells - in the bone marrow were stable and the tumor at the sternum) were stable. The lung was okay, we think.

Dr. K did say he isn't a big fan of surgery, but I just kept saying that I wanted this thing off/out of my body. I am so tired of changing wound dressings. I hope he understands that chemo wasn't controlling it.

Anyway, he is okay with the surgery and said he would trust the surgeons when they say that this is the right course of action.

I am so ready!

Countdown: 7.5 days and 15 dressing changes.

A Muffin Top

I am proposing a third definition of "muffin top". The first is the real thing - a muffin in which the top spills over the cupcake cup.

The second is also sometimes referred to as love handles - the part of your stomach and sides that hangs out over your pants when you gain weight.

The third is what my wound care nurse and I saw yesterday in my armpit.

Yes, the growth in my armpit is starting to look a bit like a muffin top.

About 11 days ago, I started putting turmeric spice on my dressings so that the growth/wound always has the spice (which has anti-cancerous properties) on it.

I also had a Herceptin treatment.

Now, remember that I have tended to think that the immunotherapy (t-cell therapy) and the Herceptin is effective against the cancer in my body. I also said once or twice that I sometimes imagine that my body is pushing the cancer out of my body, through the wound in my armpit.

Who knows, really, if the turmeric is working in the wound - although it hasn't grown as much in the last week as the previous two (was it the Herceptin, too?). But since I started using it and since the Herceptin treatment last week, the growth is starting to pull away from the skin in a few spots. In other words, the growth appears to be the muffin top that is spilling over, creating a bit of a crevice underneath it. In other words, there is space between the growth and my skin underneath it a couple of places.

My wound care nurse, L., was a bit excited. She said she's used to seeing the cancerous tissue create a bit of mountain, with the slopes of the mountain going down to the skin.

I think, in other words, that my body is starting to squeeze the growth out of my body. Imagine taking a muffin and squeezing the muffin cup (i.e., the bottom part) and having the muffin squish out the top. By cutting off the growth about my skin level, it's making it easier for the surgeon to cut out the growth.

I'm going to start visualizing that every day before surgery: my body pushing out the cancer so the surgeon can get to it and get rid of it. I'm imagining that there's good tissue underneath it.

I go to Portland tomorrow to see the plastic surgeon and to do labs. I'll know more about how long I'll be in the hospital and what to expect afterwards.

Countdown - 15.5 days and 33 dressing changes.

Countdown to Surgery - 16 1/2 days

. . . and 34 more dressing changes!

Can you tell? I'm looking forward to this upcoming surgery!

: )

YAY! Surgery is April 1!

Yay! OHSU was able to move my surgery up to April 1.

YAY!

No more skin wound.

No more growth.

And, here's hoping that the cancer is contained inside me with the current regimen. Time will tell!

YAY! The countdown begins! 18 days and counting!

Whew.

Revisiting Herceptin Side Effects

I love having this blog. Occasionally, I will use the "Labels" in order to look up some topic that I've written about before. I decided to see how Herceptin affected me 14 months ago, when I first started taking it.

Fatigue - check

But also, there was a post from a year ago where it said that after a few days, I begin to get really hungry and want to eat a lot. I figured my body wants the energy in order to remove the dead cancer cells from Herceptin as well as to heal.

Great Appetite - check

No word yet from OHSU. Still no official date for my surgery. I'm not going to fret . . . it will happen when it happens. I want it to happen sooner, of course, due to the pain, but I think I'm getting a good system for pain relief going.

Have a great week everyone!

Increased Pain and Dad is Still in the Hospital

I've been getting increased pain and am trying to figure out the right dosing schedule to keep me relatively pain free. I take the gabapentin (generic neurotin) in the morning with breakfast then a few hours later, I'll take Tylenol, then gabapentin with lunch, then Tylenol, then I guess I took Tylenol in the evening since gabapentin makes me tired - so I'll take that right before bed and I end up sleeping really well.

I think I may have mentioned that OHSU will not be able to get me in for a surgery until April 22. Since I think the lesions are continuing to grow, 7 weeks seems a long time to wait. So, I decided to try turmeric - I tore apart the capsule and am now sprinkling the spice on my dressing and putting it directly on the wound. I started it last night. We'll see if it makes a difference. I think it might be making it drain less, but I don't know that for sure.

Also, I may have caught some kind of respiratory infection - I seem to be coughing more but usually only after I eat any hint of sugar (even a clementine made me cough) or dairy.

As for my dad, she "crashed" on Friday night - her heart rate went really low (into the teens), so the "rapid response team" came into her room (all 6 of them) and worked on her. Good thing she hadn't come home yet since they could get help to her really fast. She also went low again last night with a heart rate in the 40s. She's also nauseous, probably from the antibiotic (Levaquin - which made me nauseous) and is back to not eating much. The docs decided to give her a permanent pacemaker, which we thought might happen tomorrow, but dad's white blood cell counts are high, so she may have an infection. If so, they don't want to operate until that's under control - they could infect the heart. They are taking blood cultures and doing other lab work to see if she has an infection. They won't know the results until Tues, which means the earliest she could get the pacemaker is Wednesday.

And, so we wait . . .

A Friday

I canceled my dental appointment today - figured if I'm fighting some infection, I shouldn't have dental work done.

I took Eddie to school. Then relaxed for a bit, took mom to the hospital, then went to my office to meet with a student. We had a great conversation - this is one of the reasons why I love my job.

But because I was still tired, I came home. Watched a movie. Tried to work on a syllabus, then picked Eddie up from school.

Relaxed some more. Worked a bit more on the syllabus.

Then, it was time to go to Eddie's school's auction. The food was good and got caught up on the latest with a couple of other moms. I helped a bit with data entry on the silent auction items, then I got tired when I finished that part, took Eddie and came home. Good thing, too, my dressing was just starting to leak.

Dad was supposed to come home today, but she had a bit of a panic attack and had some arrhythimia, so they decided to keep her until tomorrow.

I'm going to take Eddie to play laser tag tomorrow and we'll meet the son of another of the Puttin' on the Pink models. That will be fun. Other than that, pay bills, submit claims to the health care spending account, work on a syllabus, and work on a powerpoint for Monday's presentation.

Whew.

Oh, I forgot. OHSU is not able to schedule the surgery until April 22nd. Something about how one of the docs didn't have an 8-hour block of time for the surgery. Which sucks because the mass under my armpit is growing slowly and causing some more pain. My brother accidentally bumped into my right shoulder yesterday - and his shoulder hit one of the growths. It hurt and now that particularly growth has like a black or dark purple bruise. In other words, the sooner I have surgery, the better.

I'm going to have a Herceptin treatment on Tuesday, but I'm thinking something more drastic is going to have to happen sooner rather than later.

Health Updates

I apologize for not posting more often. I've been busy as usual, but also tired.

Dad is still in the hospital, but now out of the ICU. She is walking farther and faster, which is good. However, they haven't been able to drain the fluid from her lungs because her blood is too thin. So, she can't take in a full breath and is still on oxygen. If they can drain the fluid from her lungs today, then she will probably come home on Friday. When she comes home, she may be on oxygen and use a walker, so we need to make the house somewhat handicapped accessible.

As for me, because the operating rooms at OHSU are in such demand and the surgeon and plastic surgeon are busy with surgeries, it looks like the earliest I'll get in for surgery is April 1. This is good because it will allow our family to adjust to having dad at home recuperating from such a major surgery.

This is bad, though, because I am getting increased pain. I mentioned how the upper back of my left arm is tender and sometimes tingly and numb to the surgeon and he mentioned that the cancer is probably in the nerve (or around the nerve?). In the last couple of days, I've also felt pain in the front of my arm/shoulder and extending down the underside of my arm. Also, I discovered the back of my hand is tender. Then, when I raise my arm level, then flex my hand down, I can feel a tightness (cording?) in the muscles or nerves on the back of my forearm and ending in that tender spot on the back of my hand.

So, since the surgeon planted the idea that I had nerve pain in my head, I contacted my oncologist's office and he started me on the generic drug for neurotonin. I had it last night and it put me to sleep. It also took care of the pain, but now I can feel it again, so time for another one.

I can't really sleep on my left side anymore, so it's either on my front or my back and sometimes the pain bothers me when I sleep on my front. So, now a sore back since I'm sleeping more on my back. I'll need to get a bolster for my knees.

I'll have another dose of Herceptin and Zometa next week as neither of those targeted therapies compromise my immune system for surgery.

An April 1 surgery messes up my teaching schedule - I canceled the second day of classes on March 31 since a lot of our students will be at a conference anyway. I have colleagues coming in to talk to my class on March 29, April 5, and April 7.

I was also supposed to go to Vegas for a conference April 20-23, but that will only be three-weeks post-surgery, so I don't think I will be able to fly . . . will have to ask about that.

The stress got to me yesterday. Something happened at work that tipped me over the edge. Luckily my therapist helped me through it and I'm less upset about it.

I'm also dropping a lot of balls at work and only doing the bare minimum.

It will all work out. Time to begin living in the moment . . .

Home from Vegas; Dad is doing better

I got home from Vegas last night - roads were okay since the weather system didn't hit until early morning today. I picked up Eddie - it was great to see him again!

This morning, we woke to a few inches of snow, but I still drove Eddie and me to our appointments. Then a friend of mine, R., kept me company to go to OHSU, just in case the roads were bad. But the roads were fine.

I met with both the surgeon and plastic surgeon - I really like both of them! They are going to try to schedule me for surgery ASAP, which may be the week of March 14. I will keep you posted once it's scheduled. It's going to be a long surgery - maybe 7 or so hours. But they feel they can take care of the area under the armpit and reconstruct the tissue there. They said that I have the distinction of being a "unique" (or "unusual"?) case. Dr. P (the surgeon) kept saying even though one or two options are closed because of prior treatments, there are other options. They will take the latissimus muscle on the left - probably the whole muscle - to reconstruct the armpit. They will take out the implant - so I will be flat for awhile. But a much more positive experience than with Dr. *##!

Dad is doing okay. She got up to walk around twice today. I saw him this morning and was able to tell one of the docs to "stop barking at her" and to "ask gently" to move. The nurse (N.) gave me a thumbs up and said I did the right thing!

I am about to go up and say hi. We had to wait for the nurse shift change to see her. I'll write a P.S. with news . . .  

P.S. Dad was okay. Drifting in and out of sleep. Chatted with the nurse about his recovery. Send healing energy her way somshe can get a good night's rest. Love to you all . . . Thank you for your good energy, thoughts, and prayers so far.

Vegas from Mon to Wed, OHSU on Thurs, Cabin Fri to Sun

A few weeks ago, as I was chatting with my Hawaiian friend and colleague on the phone, I invited myself to visit with her and her family when they are in Vegas this coming week. I leave tomorrow afternoon and come back Wednesday evening. We plan to see Cirque Du Soleil Zumanity and also go to Red Rock Canyon. We need to tie up some loose ends from the Hawaiian workshop, too.

While I was in Portland, I got a call from the doc's office at OHSU - I will see him and the plastic surgeon (a female) on Thursday afternoon. I'm not sure how quickly they can work me in for surgery, but I'll know more next week.

Then on Friday evening, I head to a cabin in the woods with my coauthor - we are writing a paper called Seabirds of King Island. It'll be good to have that time to chat together.

And, I have two applications due March 1st and one on March 7th.

Dad had chest pains the whole time we were in Portland, so she went to the ER last night. They've run all kinds of tests, all came back negative (or normal) until the stress test today, which she couldn't finish. The doctor also listened to various arteries and heard abnormalities, so they suspect it's angina or clogged arteries in her heart. They will do an angiogram tomorrow to be sure and then they will decide to do.

It's gonna be an interesting week . . .

CT Scan Results and Visit with Dr. K

Or, aka, "Some Good News and Some Expected News".

The good news is that the treatment regimen appears to be working systematically, that is, throughout my body, in my system. There appears to be only scar tissue in the lungs now - *maybe* one spot that may still be a tumor, but for the most part, the areas are smaller and it looks like scar tissue. I had multiple spots in my lymph nodes in early fall - no mention of those on this CT scan. And, a suspicious spot on the liver (which Dr. K didn't think was a tumor) is gone.

So, the treatment is working at some level. That made me feel better about how fatigued I feel. I'm not quite bouncing back from the last chemo - it's getting harder to do so. Even today, ten days post treatment, I still feel dead dog-tired.

But the CT scan still shows a mass under my armpit - which I can see, so obviously I knew it was there. The good news is that the diseased tissue doesn't extend all the way down to the bone - there's a nice layer of tissue so the surgeon might be able to get 90-99% of the cancer there. Also, there's a spot that is on the scar tissue of my TRAM flap breast, near the breast bone, is apparently a tumor. It's grown in recent months, but I didn't really notice it until a month ago. It's a hard nodule about 3cm long and maybe 2cm wide. Plus there are spots in the bone marrow, but it doesn't look like there are more of them since the last one.

So, what's the plan, man?

Because February is a busy month for me with all sorts of work and fun activities, and the surgeon, Dr. F, is away at a conference around March 3-4, it looks like I will have surgery the week of March 7. That will give me three weeks of recovery before classes start March 28.

So, I have my last HAZ treatment on Friday the 28th - Herceptin, Abraxane, and Zometa. Then, I will have another Herceptin treatment upon my return from Hawaii on Feb 14th and before we go to Eddie's school tournament. Then, I'll have three weeks off of any chemo before surgery.

I'll visit the radiation oncologist in mid-February because we might do some radiation to get rid of any residual cancer in the area. And probably do radiation on the nodule near my breast bone. That may happen through the beginning of spring term.

There's some light at the end of the tunnel, in other words. In six weeks or so, I will be done - you hear that, DONE - with the wound in my armpit. I'll say that again, DONE with dressing changes in about six weeks. DONE.

Can you tell? I'm happy about that.

Afterwards, we just need to start thinking of what to do next. That'll depend on where I stand.

This also means that beginning two weeks after my last Abraxane treatment, around mid-February, my hair can start growing back. That's good because I think my eyebrows and eye lashes are definitely thinning out lately. I haven't had bushy Eskimo brows in a few months! LOL

I also hope that Dr. H, the plastic surgeon, can get rid of the dog ears at my waist since he will be there anyway taking tissue from the Lat area for a LAT flap. He may also need to take out the implant and put in another one since Dr. K and I could both see that the cancerous tissue went all the way to the implant. I hope that they make implants that are flatter - i.e., not so round - since my TRAM flap boob is flatter rather than round. He said he can also lower it so that I'm more even.

Looks like it will be a good spring for me - no wound, maybe more even boobs, no dog ears, and hopefully, NO CANCER!!! Well, there will always be evidence of cancer in my bone marrow. But let's say NO GROWING CANCER!!

Oncologist Today

I saw my oncologist earlier today and showed him the wound with the satellite lesions. He was a bit disappointed because he had heard that my tumor markers had really gone down dramatically. But he agreed that I had plateaued - or rather that these satellite tumors are apparently resistant to the Abraxane. So, we will change it up again.

I told him my theory about not having t-cells to fight the cancer along with Abraxane. He will talk to Dr. D at UW about this, I think, to make sure I'm telling the story correctly. I wondered if maybe I go off Abraxane and allow my lovely Herminator-2 cells to regenerate. He didn't really think that that was advisable. I don't blame him.

He will also talk to Dr. D in Seattle about using Imiquomod with Abraxane, although it's his understanding that Imiquomod (an ointment) usually works only on superficial lesions whereas my lesions are deeper in the skin tissue.

We also brought up other options. One is to add Herceptin back into the mix with Abraxane. Another is to just do Herceptin. And, the fourth option is to do surgery.

So, a variety of potential courses of action. I'm okay because I know we'll do something. I do have faith that by the time we knock out those satellite lesions, by whatever method, I'll be in some kind of remission. So, just a few more months . . .

Visit with the Surgeon aka Wait and See

I saw both the wound care nurse and the surgeon today and the consensus is that the armpit looks great and appears to be healing as the cancer is dying. So much so that the surgeon wants to wait and see what Dr. K (my oncologist) says when I see him in two weeks.

Last week, after my visit with the wound care nurse, I began to suspect that I might not need plastic surgery at all. I ended up going back to my blog to see what Dr. D from UW said. In my blog post (), she said that once the chemo has killed the cancer in the area, it would probably heal within about six weeks.

So, we're waiting to see what happens. Which means, for now, no surgery in December because if it were going to happen, we'd need to start planning it now rather than later. This delays surgery until after the New Year . . . and at this point, because I'm heading to Hawaii for a workshop for work in early February, I'd probably even wait until after that to do anything.

And, you know, that's fine with me. Because if I do have surgery again, I'd rather it be to fix my lopsidedness and to trim the "dog ears" at my waist. And, I'm happy to allow the t-cells (Herminator cells) and Abraxane to keep doing their thing. : )

Visit with the plastic surgeon . . . and side effects

I saw the plastic surgeon today and ultimately, he said that he would do the lat-flap surgery (use the latissimus muscle under my armpit) and that ultimately the timing of the surgery would be up to Dr. F, my surgeon. So, I'll wait a couple of days and then call Dr. F's office to schedule an appointment and talk about timing.

There's a part of me that wonders if the whole area would eventually heal itself. However, I remembered that the wound probably wouldn't heal as long as I'm on Abraxane. Dr. K would like for me to be on Abraxane for six months, which means that I'd end up with an open wound for at least that long. And, with an open wound comes the risk of infection, like I had last month. I also have a surface infection, too, which looks like a green discoloration on my dressings. It's "pseudomonisis" which is the bacteria that grows in your vases when you have flowers. I've been trying to get rid of it for almost a week now. It got a little bit better after I saw the wound care nurse - as she cleaned the area really well - and even though I've cleaned it with iodine once and have been trying to flush the area with saline, it's hard for me to do this without getting saline everywhere . . . Anyway, I guess I think that that armpit area seems to get infected easier than the other wound I had, so I might as well get the whole thing repaired to decrease that infection risk.

I told Dr. H (the plastic surgeon) that Dr. K (my oncologist) would be willing for me to take about a 6-week break from Abraxane in order to have the surgery, and probably even more so now that my tumor marker dropped so much in just one month, so that there will probably be very low levels of cancer cells running around in my system. Then, after I am recovered from surgery, I would go back on Abraxane to knock the rest of those cancer cells out.

I also asked Dr. H if he could trim the "dog ear" that was left at my beltline from the reconstruction surgery. He said that he would. I also asked if he could drop the implant down to match with the TRAM flap and he said that he'd rather not mess with it, since I have such a major wound on the armpit and he didn't want to open anything else up. If, however, cancer or bacteria got onto the implant, he said that it would have to come out. So, in the end, he said that he might bring in a spare implant and would try to drop it farther down into the pocket, so he might be able to make me more lopsided. That is, if the implant had cancer or otherwise had a risk of infection.

So, in terms of other side effects, I wanted to report that my scalp is now breaking out in zits. It's also pretty tender in some places. Now, I have to figure out how to take care of the scalp - one website said to treat it as you do your face, with milder moisturizers and cleansers.

In addition - and forgive me if this is too much information (Daria at LIving With Cancer also wondered about reporting these side effects the other day in her blog; in the interest of passing on my experiences to other cancer survivors, I'm telling my readers what's going on) - I have had some constipation (from the anti-nausea meds). I have some Chinese herbs from my acupuncturist that seemed to help me become regular again sooner than I did previously. But, last night, my stomach muscles starting cramping again. I think I reported that it seemed to do that the evening of my treatment. But this time, it happened three days later. It's been acting up all day, too. It seems to cramp up a couple of hours after I eat. And, I have had some mild diarrhea off and on all day and the cramps seem to get a little bit better afterwards. So, I started wondering if the cramping was happening in my intestines rather than in my stomach - and that they are cramping trying to get the food processed through my digestive system. So, I'm trying to drink lots of water. And, it's all complicated this time by having a head cold and taking some nasal decongestant medicines. (I am going to do my best to avoid crowds and public places while I'm on Abraxane - I don't need to deal with colds on top of my other health issues!)

So, a talk with Dr. F is in order sometime this week. I see the wound care nurse tomorrow and will also see what she says.

Plastic Surgery Is in My Future

In an earlier post, I mentioned that I thought the plan with the wound in my armpit was to allow the chemo to kill the cancer, so then the good healthy tissue could start rebuilding new tissue in my armpit. And, when chemo kills more of the cancer, the surgeon would debride the dead tissue away, making it a better environment for new tissue growth.

Well, I guess that's not the case. The surgeon, Dr. F, didn't want to resect (remove) the dead tissue surgically because it was attached to too many other structures (muscles, etc.). But today, after he took a look at the wound, there was a lot more dead tissue. He feels that I'm responding to the chemotherapy treatment rather well. He removed a lot more dead tissue. And, now the whole area in the armpit is "loose", meaning that it's not attached to the structures underneath. This means it will be easier to resect. The whole area is about 6" x 8" big.

Dr. F asked how long my course of chemo would be. Dr. K planned for me to have two months worth (3 weeks on, one week off). Dr. F felt that at that point, there would be enough cancer/tissue death for surgery to remove all the dead tissue. But since the area is so large, we would need to use a "lat flap" (tissue from my shoulder blade area) to replace the tissue in my armpit. That tissue will probably never come back on its own. That was something I guess I didn't understand before.

(My red blood cell counts were rather low and they were talking about doing a blood transfusion, but I guess it isn't low enough, so no transfusion. I also haven't had many side effects yet from Abraxane - just fatigue. My stomach gurgled a bit last night. Some constipation from the anti-nausea meds. But it's doable. We'll see next week what happens with my hair.)

So, sometime before Christmas, after two rounds of Abraxane and a couple of weeks to get my blood counts up, I will probably have tumor resection in my armpit, followed by plastic surgery to replace that tissue. I hope at the same time that Dr. H (the plastic surgeon) will be able to make my boobs level again (i.e., probably lower the left implant a bit) and take the corner off the scar at my belt line.

I am getting used to the idea of this surgery - Dr. F mentioned it last week, but at that point, it was hypothetical. But now it looks like it's reality.

I kinda wondered in the back of my mind about the amount of tissue death and if my body would be able to repair such a huge hole. So, I guess I know now.

I'm kinda relieved, to tell you the truth. I'm supposed to go to a workshop in Hawaii in February. This means that I will be able to go into the ocean! Because I won't have an open wound!!! This means I may only have an open wound for two more months!!! Even better!!!!

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?