You've GOT To Be Kidding...

Have you ever noticed when you say those words... "You've got to be kidding/joking"... that whoever (or whatever the circumstance) you utter the words to (or about)... is generally anything but a 'joke'.  

With that in mind... 

I have a surgery booked for this coming Wednesday (Feb/4th) for a matter totally unrelated (I hope) to my Breast Cancer.  While going through my list of 'woes' with Dr. Okorn a couple of weeks ago, we spoke about my continuing to have unusually heavy/irregular periods and much more pain than I'd experienced in the past.  She suggested I go to see a gynecologist to discuss the possibility of having an Endometrial Ablation.  I wasn't really sure I could handle (physically or mentally) taking on any more than I already had on my plate... but the doctor told me I really should at least find out what was causing this.

  So... I'll add yet another doctor to my list... Dr. Karen Jones.  I got in to have an ultrasound done on the day of my first visit with her on Jan/21st.  During the ultrasound the technician excused herself and said she had to have a doctor check over the images to make sure she had all she needed to send back up to the Gyn.   After waiting about 5 min, she returned with a doctor to check out something she was seeing that she was unsure of on the images.  She assured me it's not an 'alien' (thankfully :p) but we still don't know what the 'area  of concern' actually is.

  I had a follow up with Dr. Jones on Jan/28th and she explained that regardless of whether it's a 'good time' to be having another surgical procedure, we really have to find out what this is.  She explained that she won't know what it is until the tissue is seen and possibly still won't know what it is until results come back from pathology (usually four days after surgery).  Most likely is a benign fibroid (which I am hoping for!).  It could also be just an unusually thick area in the wall of my uterus, a benign tumor on the inside wall or... something worse... I'll leave that for when/if I have to worry about it.  

  Before all this came up... I was anxious about my upcoming consultation with Dr. Miles (plastic surgeon) for my final meeting with her prior to my breast surgery.  My meeting with Dr. Miles is scheduled for Wed/Feb/4/10:30am... Now I have to focus my thoughts on how I can get from one side of Swedish Medical Center (after seeing Dr. Miles) to check in at Patient Registration at 11:00am for my surgery with Dr. Jones which is scheduled at 1:00pm!

  Maybe this is the Universe's way of keeping me on my toes?? Perhaps in my next life I'll come back as a Prima Ballerina :)

I've Requested an Early Valentine's Day...

As my surgery is scheduled for February/10th @ 7:30 am!  I will be having Sentinel Lymph Node Biopsies on both sides at that time as well and will have to have the dye injected the day prior.  I understand the importance of removal of these nodes to detect if any Cancer has left my breast(s) but am a little uneasy about the potential complications and/or side effects of the procedure.  I think this is one of those circumstances where I need to 'educate' myself without reading 'too much'!

  The surgery should take about 5 hours and if all goes well (which I'm sure it will!) I should be able to go home the following day (a two day stay in the hospital at the most!).  I realize that everyone is very different regarding recoup time, but I'm hoping for the 'fast track' of recovery and hope to be up and mobile within a few days!  From what Dr. Lee has told me from her experience, I will likely be more 'tired' than 'sore'.  One of the most important things for me to do will be to make sure I don't try to 'overdo' it!  Many women (after mastectomies) feel so good they forget to limit their upper body movement and end up making matters more difficult for themselves. 

  I've been reading lots of 'helpful tips' on what to do ahead of time, like moving items I use regularily from upper to lower shelves, do some extra cooking/baking the week before surgery and have things ready to thaw/heat up easily, give the apt. a good cleaning, etc., etc...  I've also gotten back on track on walking/running and am doing some Pilates here at home to get my body ready for the ordeal.  Being as fit as possible going into any surgery is a great way to help your body get ready to heal :)  I've always been a really great/fast healer... so I don't have any worries in that area!  

  I had a very nice talk with my primary doctor, Dobrina Okorn yesterday.   I had called on Tuesday in hopes of getting in to get a prescription for something to help me sleep and was told she had 'absolutely nothing' available until next week.  I requested a message be passed along to her, simply stating my name and that I would only need a few minutes of her time.  Literally seconds later, her nurse called back and set up an appointment for the following day.  I expected to have an 'in and out' visit with a prescription in my pocket and instead had her undivided attention for about 40 minutes :)  

  We talked about all that's happened since we first met on Aug/13/08.  Though that was the only time we'd actually 'seen' each other, she gets copies of all of the reports sent to her and had called on a couple of occasions to see if I was okay and if there was anything she could do for me.  After talking for a while yesterday she suggested I take a mild antidepressant as well as a mild sleep aid.  The antidepressant is something that is routinely prescribed for people having trouble sleeping and as well will hopefully help my chemicals get firing on all cylinders to help me cope emotionally with all of this.  And since I've coincidentally, seemingly ventured into the beginnings of menapause (night sweats that constantly wake me up) the sleeping meds should help me sleep through the night.  *funny I feel pained by saying I'm entering menopause... I'm slowly getting used to saying 'I have Breast Cancer'... perhaps that will get easier to say too??*

E  X  H  A  L  E... 

  Right now it is actually a relief to have a date for surgery and to feel 'a little' more comfortable about accepting that this is all happening to me.  Like most things in life, the first steps are the most difficult... 

*Deep Breath* ...

... and *E  X  H  A  L  E* .... 

  Decision making can be very nerve wracking.  I have gone through it with others and have had many struggles myself over things like: Which flight to book, what laptop to buy, get married/get divorced, start a business/end a business, what nail polish color to choose, have the lamb or the halibut, Pinot Gris or Sauvignon Blanc...  I sat down yesterday afternoon with Christine Lee (my Breast Surgeon) and started our conversation by giving her a brief overview of the past 14 months of my life and some of the other 'decisions/situations' I've been faced with (I won't bother recounting the events here... most of you reading this will know some... I gave her a 90 second snapshot of pretty much the whole 9 yards).  She sat and nodded as I spoke, her face soft and eyes caring... and then we began to speak of the matter at hand.  

  We went over the notes from Robert Resta (Geneticist) regarding my results from my BRCA1&2 tests, agreeing that although nothing definitive... a (slight) load off of my siblings and a welcome departure from having to be concerned about my Ovaries (at this time).  We also talked about the meeting David & I had with Wandra Miles (Plastic Surgeon).  Dr. Lee asked if I was going to continue to meet with other Plastic Surgeons (in hopes of finding a 'good fit' for us) and I told her that I was very comfortable with Dr. Miles and saw no reason to look further; it was only after this that she made it apparent that she trusts and enjoys working with her (even making a joke about 'if there are any problems with your surgery it will be Dr. Miles' fault... not mine' :).  I found this a very becoming quality, as she seems to go to lengths to allow me to make my own choices throughout all of this.  

  I told her that I have decided that I want to schedule surgery for a Bilateral Mastectomy with Immediate Reconstruction, with Dr. Miles placing the expanders on the same day.  She said that although she fully understood the pressure I am feeling and the level of anxiety it is causing, that she felt confident that I was making rational decisions for the right reasons and fully agreed with my choice of procedures.  I should have the date for my initial surgery within the next couple of days and hope it will be sooner than later.  Dr. Lee explained that since I'm having the Immediate Reconstruction it will make scheduling a little more complicated as not only will both of them have to be available on the same day but a larger block of time will be needed for an operating room.  Now that I have the wheels in motion and am firm in my heart and mind about the procedures... I hope they call and say it's next week!  I'd really like to get started to be closer to getting finished!  

  I was well prepared with a (long) list of questions as well as a voice recorder and will post notes later on what I learned yesterday.  For now... this is the information I received from Dr. Miles a few weeks ago... the information that caused me to go into 'meltdown' when I first read through it.  It's still by far my 'favorite read'... but gets a little easier to handle as acceptance settles in... 

TIMELINE FOR EXPANSION

1. Surgery Day: Once it is determined that you may have immediate reconstruction, placement of the breast tissue expander is done immediately following your mastectomy.  This adds approximately 1 1/2 - 2 hours to your surgery.  After surgery you are in the recovery room for about 1 hour before being transferred to your hospital room.  It is common to stay 1 - 2 days before going home.  

2. Stitch and Drain Removal: You will see Dr. Miles one week after your surgery to have your stitches removed and dressing changed.  Sometimes you will have seen your general surgeon before this and she may have changed your dressings.  Your drains will be removed by Dr. Miles ( or your surgeon) based on the amount of output.  The goal is for your output to be less than 20 - 30 cc from each drain per day before removal.  

  You will also be seen by your surgeon (or oncologist if necessary) 1 - 2 weeks after surgery to discuss your final pathology and treatment plan if needed *Let's all cross our fingers/toes that we don't have to go there*

*and another Deep Breath*

3.  Two Weeks Later: First Expansion!!  Providing that your wound is fully healed, we will begin expansion of the tissue expander.  This is done by either Dr. Miles or her nurse.  Take a Tylenol or Advil 30 minutes before your appointment.  This helps with any pressure you may feel afterward.  It is not uncommon after these expansions to feel muscle spasms in your back (especially at night) for a couple of days.  You may use your muscle relaxer medicine that Dr. Miles prescribes or your pain killers.  

4.  Weekly Expansions: You may come in once a week to be expanded or you may space these visits as far as you wish.  How many weeks this total process takes will be determined by how large you wish your breasts to be.  Generally we aim for symmetry with the unaffected breast.  Patients having both breasts being reconstructed generally have the choice of size open.  

5. Done Expanding.  After we reach our determined size, then we wait a minimum of 3 MONTHS to let the skin and muscles settle.  You can begin contemplating upon a date for your surgery to exchange your expanders for permanent implants.  We will discuss this with you at this time.  

6. Surgery To Exchange Implants:  Great Day!!  This takes about 2 1/2 - 3 hours and is an Outpatient procedure.  You can go home on the same day but also have the option to stay overnight.  Generally we do not need to put in drains for this surgery.  

7.  Stitch Removal/Dressing Change:  In 6 - 7 days we will remove your stitches and change your dressings.  Now we will have to wait while the implant 'settles down' before we can create nipples.  

8. Nipple Reconstruction:  Three months later.  Yes, 3 MONTHS.  The breasts change as the implants settle, and belly out and the breasts soften.  Now we decide on where the nipples should be.  Let's book surgery!

9.  Nipple surgery:  This takes about 1 1/2 hours and after recovery, you may go home.  It may also be done as an office procedure.  Dr. Miles will discuss this with you.

10. Stitch Removal: One week later we remove some of the stitches.  We remove the remaining stitches one week after this.  

11.  Tattoo:  Usually one or two months later, we will pigment the areolar/nipple complex.  

LET'S REVIEW:

1. Mastectomies and insertion of tissue expanders (Inpatient Surgery).

2. Two weeks later, first expansion.

3. Expansions every week until target size reached.

4. 3 Months later, exchange tissue expanders for permanent implants (Outpatient Surgery).

5. 3 Months later, nipple reconstruction surgery (Outpatient Surgery).

6. 1 - 2 Months later, tattoo nipple/areola.

7. 1 Month later, check color match.

8. DONE!! DONE!! DONE !!

TOTAL TIME: Approximately 9 to 12 Months.  

... *and another ... DEEP BREATH* ... 

The top example on this page  (taken from a random Plastic Surgeon's website) is a very 'successful' depiction of the procedures and an explanation of the progression.