Cancer Lesson #21: This could get complicated.

Cancer Lesson #21: This could get complicated.

As with any surgery, a TRAM flap can result in complications. Being I am a hopeless nerd, I researched the ramifications of every possible choice before deciding to pursue this type of reconstruction immediately after my mastectomy.

My plastic surgeon responded to this request by providing a detailed explanation of the surgery. Then he described the possible side effects up to and including death. We also discussed other procedures and their possible complications.

I had to fight the urge to giggle though I know it wasn’t funny. It just seemed odd to be considering the possibility of death via reconstruction when I was walking around with a cancer time bomb in my breast.

Besides, death is a possible complication of practically every medical procedure you can name, including many we think of as routine.

For that matter, death is more or less a complication of living.

I could deal with the <1% chance of death by TRAM flap. It was the possible side effects of chemo – puking in particular – that worried me. And the needles. The idea of the needles scared me spitless.

Still, if you’re considering a TRAM, you should be aware of the possible complications, which are listed here: http://tinyurl.com/oyacobe.

As always, I am not a member of the medical community, and nothing I say should be construed in any way as medical advice. Any decisions about your care should be made by you and your doctor. Yada, yada, yada, I know, but I don’t want  anyone thinking I can provide guidance about their treatment.

Related articles

• Life After Breast Cancer: Considering Reconstruction (breastcancer.answers.com)
• Mastectomy, DIEP flaps, and doughnuts, oh my! (kristahaapala.com)
• Well: No Quick or Easy Choices (well.blogs.nytimes.com)
• Breast Friends: Why Angelina Jolie’s Mastectomy Matters (narcissista.me)
• Breast Reconstruction After Mastectomy: Is It Right for You? (everydayhealth.com)

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Cancer Lesson #18: All cancer patients have a date with destiny.

Cancer Lesson #18: All cancer patients have a date with destiny.

I believe there comes a time in each patient’s life when s/he is excited to get the date of his/her surgery and/or commencement of treatment. My particular date was Wednesday 27 April 2011, and I was thrilled to be getting the show on the road.

Before that, I had a minor “date with destiny” in the form of my plastic surgeon, Dr. K2. By then, I had to decide if I was going for the vavoom factor or a more natural look.

When I wrote about this in my blog, I said, “That’s w-a-y more than you needed to know, right? And yet, I feel so unrepentant.”

I refuse to be embarrassed by the things I wrote then and am writing now. I’ve shared my cancer lessons because it’s important for others to realize this is something they can survive. And face it, there are a lot of bizarre things about being treated for cancer. How could I not write about the experience?

Related articles

• Is Cosmetic Surgery the Best Choice for Breast Cancer Patients? (mwarrington6851.wordpress.com)

Cancer Lesson #17: An Equation

Cancer Lesson #17: An Equation

As mentioned in Cancer Lesson #6, my cancer was ductal, one of the most common varieties of breast cancer. After all the scans and blood draws, it seemed to be just as it appeared – with a single site that had spread to at least one lymph node.

I was lucky. My doctors told me since I was “young” (ha) and “fit” (double ha), I had choices, which I wrote into an equation that looked like this: (R + L + C) = ([M + {r1 or r2}} + C)

R is radiation, L is lumpectomy, and C is chemotherapy. M is mastectomy, and r1 and r2 were my options for reconstruction using implants or a TRAM flap. Of course, there was also the option to not do a reconstruction and wear prosthesis for the rest of my life, a choice many women make.

What was not an option was avoiding surgery altogether. And since my cancer was already in a lymph node, a sentinel node biopsy – where they remove only a few lymph nodes to verify the cancer hadn’t spread – wasn’t advisable. I needed a axillary lymph node dissection, which meant Dr. S would remove as many lymph nodes as she could find to see how many were affected.

The first part of the decision was easy. I’m small-breasted (read “flat”), which meant even a lumpectomy would be noticeable. Plus, I didn’t want to have radiation.

I could have had a bilateral mastectomy, removing both breasts and thereby considerably lowering the chance of recurrence, but that seemed like overkill. Also, if I decided on a TRAM flap reconstruction, I didn’t have enough stomach or back tissue (fat) to make two new breasts. (Too bad they don’t use thigh and bum fat!)

So, a single mastectomy it would be, but with what kind of reconstruction?

Choosing implants meant my new breast could be any size I wanted, and the plastic surgeon would make the other one match. A TRAM came with size limitations, but without the possible later complications involved with implants. (As WebMD says, “Breast implants are not designed to last a lifetime.” See here for the rest of the article: http://tinyurl.com/mkte47w.)

The decision, in my mind, came down to this: Did I want to have look like more like Barbie or like me?

I got a lot of comments on that blog post and the accompanying Facebook status, ranging from “Go for it!” to “Women aren’t beautiful because of their breasts; they’re beautiful because who they are.”

One friend, who shall remain nameless, commented that he’d always had a fondness for the airport in Salem, Ohio (airport identifier: 38D). Having pretty much settled on a TRAM by that time, I replied that I would probably continue to have a lot more in common with Laurens County, South Caroline (airport identifier: 34A).

Interestingly, the “go for it” and the “you’re beautiful just as you are” comments were equally divided between women and men.

The Engineer wisely didn’t state a preference. Finally, in a fit of self-pity (using my most pathetic voice), I asked him, “Will you still love me when I don’t have a real boob anymore?”

His reply? “I’ll just have to love you somewhere else.”

It was the perfect answer.

Note: I would never presume to imply that the choices I made are right for everyone. Every option comes with complications, and only you and your doctor can decide what is best for you. 

Related articles

• Breast Cancer Treatment Options (breastcancersocietyblog.wordpress.com)
• Mastectomy Often The First Choice For Young Breast Cancer Patients (medicalnewstoday.com)
• Day 47 (mybreastcancerdiary.wordpress.com)

Cancer Lesson: Life Is a Relay

Cancer Lesson:  Life is a relay.

I haven’t assigned a number to this cancer lesson because it’s out of order in the story of the lessons I’ve learned. It’s actually a repeat of a post I wrote for my other blog last year. I’m sharing it here because tonight I participated in the 2013 Relay for Life. Beside me walked my friend who was in chemo during last year’s year’s event, as well as a another who was diagnosed just before it. Life is indeed a relay. 

I participated in Relay for Life this weekend, representing my library’s team on the track for an hour last night and during the final shift this morning.

Of course, my thoughts traveled back to the 2011 event, when I was in chemo and able to attend only as a spectator. Unfortunately, this year a good friend of mine was the cancer patient visiting our tent, and we all walked at least partly for her.

As part of Relay fundraising, you can buy luminarias in honor or memory of those who have fought cancer. These candles are lit after dark, and each name is called as participants silently circumnavigate the track.

English: OAK HARBOR, Wash. (June 6, 2008) Luminaries line the Oak Harbor Middle School track for the Relay For Life of North Whidbey. Relay For Life is a fundraiser held by the American Cancer Society to raise money for cancer research and to promote cancer awareness. U.S. Navy photo by Mass Communication Specialist 2nd Class Tucker M. Yates (Released) (Photo credit: Wikipedia)

It is a particularly poignant ceremony, and I cried for my two friends who died last year and my cousin and friend who are now in treatment. Still, I was grateful for the opportunity to pay back some of the support I received during my own fight, and amazed by the difference a year has made.

This morning, the atmosphere was different. The number of people on the track had dwindled, some of them clearly exhausted from the night before.
But they were still walking.

And finally, it struck me — the lesson my mind had been knitting together over the past twenty-four hours.

It’s this: Life is not a sprint or even a marathon; it’s a relay.

Sometimes we lead so others can rest. Other times, we can take it no longer, and someone else must take charge and be the strong one.

I remember a colleague from many years ago telling me how she and her father dealt with her mother’s long-term illness. “We have a rule,” she said, “only one of us can be crazy at a time.”

At the time, I was a relatively new parent, and thought that was an excellent approach to the huge job my husband and I had taken on in raising our daughter.

After last night, however, I understand this philosophy can be applied much more broadly. Life’s challenges are more easily faced when we can lean on others, and let them lean on us.

I don’t know if the American Cancer Society had this in mind when they established Relay for Life, but for me the event will forever be bound with the relay that is life.

 

Cancer Lesson #16: Vocabulary Lesson

Cancer Lesson #16: Vocabulary Lesson

Having cancer broadens your vocabulary. Now instead of saying, “I had breast cancer,” I can tell people, “I had a progesterone receptor positive, estrogen receptor negative, HER2 negative, malignant neoplasm in the lower right quadrant with lymph node involvement.”

The mass was a “ductal carcinoma,” and since it had spread to a lymph node, it would also be considered “invasive.”

What does all this mean?

Well, the progesterone and estrogen parts refer to whether or not my cancerous tissue was receptive to those types of hormones. That is, did those hormones help it to grow? My mass was receptive to progesterone (PR positive) and only very slightly receptive to estrogen (almost ER negative). According to WebMD, about 75% of breast cancers are ER positive. Being ER and PR positive is a good thing because these cancers can be fought using hormone suppressors. (http://www.webmd.com/breast-cancer/breast-cancer-types-er-positive-her2-positive)

HER2 stands for Human Epidermal Growth Factor Receptor 2. It also promotes the growth of cancer cells, and HER2 positive cancers tend to be more aggressive than other types of breast cancer. (http://www.mayoclinic.com/health/breast-cancer/AN00495)

“Ductal carcinoma” simply means my cancer started in the ducts – the parts of the breast that carry milk from the lobules, where the milk is produced.

Each one of these descriptors is important because they indicate where my cancer was, how much it had spread and how it grew. These facts, in turn, defined my options for the treatment of my “progesterone receptor positive, estrogen receptor negative, HER2 negative, malignant neoplasm in the lower right quadrant with lymph node involvement,” my “invasive ductal carcinoma.”

Related articles

• Novartis pivotal Phase III trial shows Afinitor significantly delays tumor growth in women with HER2 positive advanced breast cancer (prnewswire.com)
• CTI Reports Final Results from Cooperative Group and NCI-Sponsored Trial of Brostallicin in Patients with Metastatic Triple-Negative Breast Cancer (sacbee.com)
• Positive Data Supporting A New Biomarker Predicting The Efficacy Of Current Hormone Therapies In Early Breast Cancers (medicalnewstoday.com)
• Doubling Time on Tamoxifen Cuts Odds for Breast Cancer’s Return: Study (news.health.com)
• Abnormalities in HER2 gene found in wide variety of advanced cancers (eurekalert.org)

Cancer Lesson #15: Those Benign Ladies

 

Cancer Lesson #15: Those Benign Ladies

When my surgeon’s nurse called with the arrangements for the  tests I needed, she said Dr. S would see me again when the results were returned.

I could almost hear her mind whirring through the sound waves on my phone and could tell she was looking at the schedule, trying to calculate when that might be and how she’d manage to fit me in.

Finally she said something like “I’ll get you in somehow. I might have to move some people around, but those benign ladies can wait.”

“Those benign ladies” – I nearly laughed aloud.  I’d always figured patients who were seriously ill took precedence over those with more minor ailments, but hearing that reality voiced so bluntly was refreshing.

So the next time you have to wait longer than you expected for an appointment, remember it’s probably because you’re  one of the “benign ladies.”

And that’s not such a bad thing to be.

Cancer Lesson #14: “I’m radioactive.”

Cancer Lesson #14: “I’m radioactive.”

Because a bone scan involves being injected with radioactive material (and I cannot begin to tell you how grateful I was to the gentle young man who accomplished this task in one jab), the patient afterwards receives a card explaining why they might be radioactive for the next week. Just in case said patient needs to cross a national border or visit the airport and finds it necessary to explain why they are setting off security sensors

. 

At the time, I found the idea laughable, but now I understand that some patients travel many miles for their treatment. Plus, the idea of taking a vacation before surgery and chemo has some appeal.

In my case, all that happened was The Engineer kept referring to my “glow,” and for weeks I walked around hearing Paul Rodgers sing “Radioactive” in my head.