Cancer Lesson #75: Tittoo Defined

Cancer Lesson #75: Tittoo Defined
Warning: This post may be a little TMI for some readers.
Tittoo: [ti-too]  verb, –tooed, -tooing, noun, plural -toos
verb: to color a reconstructed nipple by puncturing the skin and infusing dyes.
: 1. procedure used to color the nipple on a reconstructed breast,
2. reconstructed nipple that has been colored by puncturing the skin and infusing dyes.

Sample Sentences
Verb: Part of the physician’s assistant’s job was to tittoo the breast cancer patients who had undergone reconstructive surgery.
Noun: Wow! My tittoo didn’t hurt at all — not like the tramp stamp I got in Vegas when I turned twenty-one.


Cancer Lesson #74: Happy to Be Here. Happy to Have Hair.

Cancer Lesson #74: Happy to be here. Happy to have Hair.

I find it hard to believe it’s been three and a half years since my last chemo. How could I have had surgery and treatment for cancer, and managed to emerge with a normal life once more?

It boggles my mind.

It’s a new kind of normal, of course. Though they’ve faded, I have scars to rival Frankenstein’s, and — like others who have gone through a bodily trauma — aches and pains I never had before.

For nearly a year, my chemo curls rowdily rioted around my face like the aftermath of a bad perm.

But I’m back to playing soccer, and last year I did a bike tour. I’ve also been known to attempt a cartwheel, usually in an ill-conceived fit of whimsy. The last one ended with me plopped on my bottom, but never mind.

Clearly neither my tumbling nor my soccer skills will ever win me a place on an Olympic team. And there are granddads (plenty of them) who zoom past me whenever I ride my bike.

The point is no one know if I’d ever be able to do any of these activities again, and I can.

That’s worth a cartwheel.

Having survived cancer, I know everything else is gravy. The icing on the cake. The cherry on the – well, you get the idea.

Being alive is a miracle, and I developed a mantra to remind me of that fact.

“Happy to be here. Happy to have hair.” I say it whenever I start to stress over something stupid. Sure, it’s not the most sophisticated phrasing, and maybe I sound a little silly.

I say it anyway because I know I’m one of the lucky ones.

I’m still here.

“Happy to be here. Happy to have hair.” I say it in memory of those who are not.

Take a moment to think of them. And take some time to enjoy the life’s extras too – the gravy, the icing, and the cherry on that sundae.

I do. Especially the sundaes.

Cancer Lesson #72: Don’t Ignore the Lump.

Cancer Lesson #72: Don’t ignore the lump.

Each year when I go for my annual mammogram, I get a little nervous. Some breast cancer survivors find follow-up tests very distressing, but I always feel better after being checked. Ignoring a problem rarely makes it go away, especially when that problem is cancer.

If you’ve had breast cancer, you know people like to share their own close calls.

“I had a lump once,” they’ll say. “I was really worried, but it turned out to be nothing.”

Those are the good stories.

We also hear the other, not good stories. At least one person has told me “If I’d gone to the doctor when I first found my lump, my cancer wouldn’t have been so advanced by the time it was treated.”

The most heartbreaking of all was the man who said, “If my wife had gone to the doctor right away, she’d probably still be alive.”

You may be thinking I made that last one up.

I wish you were right.

So, here’s Cancer Lesson #72, repeated because it’s so important: Don’t ignore the lump, no matter where it is or how small.

If I’d ignored mine, I’d still have cancer, just more widespread and, oh yeah, more likely to kill me.

Thanks. I’ll take that mammogram.

Cancer Lesson #61: Three Negatives Don’t Make a Positive

Cancer Lesson #61: Three negatives don’t make a positive.

A few weeks after I finished treatment, one of my favorite cousins was diagnosed with breast cancer, beginning her own journey down the same same scary path I had so recently traveled. But her path took a different turn when she learned her cancer is triple negative.

You see, breast cancer has many variations. Pathology may show a tumor responds (is receptive) to estrogen (ER), progesterone (PR), human epidermal growth factor receptor 2 (HER2), or any combination of the three.

If cancer is ER or PR positive, hormone inhibitors are used to help prevent recurrence. A cancer that is HER2 positive tends to be more aggressive, and is treated differently. (WebMD has a good explanation of this (

But my cousin’s cancer is triple negative, meaning it isn’t ER, PR or HER2 positive, hence the name, “Triple Negative Breast Cancer” (TNBC).

Because TNBC isn’t receptive to hormones, hormone inhibitors aren’t a treatment option, so she was treated with a more aggressive chemo regimen than mine, as well as radiation.

I share these facts because people sometimes assume all breast cancer is treated similarly, varying only by stage and/or size of the tumor(s). I hope you understand now this isn’t the case.

And with HER2, it seems not only can a negative be a negative, a positive can be a negative too.

For more information about TNBC, please visit

Note: I was HER2 negative and slightly ER and PR positive so I take Anastrozole/Arimidex (a hormone inhibitor), which is effective for post-menopausal women. Tamoxifen is used for women who are pre-menopausal. Here’s a good explanation of the differences from the Dr. Susan Love Research Foundation website:

Cancer Lesson #60: The Odds Might Be in Your Favor, But Just Barely

Cancer Lesson #60: The odds might be in your favor, but just barely.

Not long ago, I listened to a book about cancer called The Emperor of All Maladies by Siddarth Mukherjee.

I ordered it from the library when I was first diagnosed, took one look, and sent it back. At that point, I was feeling too scattered to even consider reading a 571-page tome about the disease.

Eventually, however, I ordered it again, this time on a Playaway audiobook and listened to it on my way to and from work. It’s more than twenty hours long, so it took a while. It was fascinating stuff – a Pulitzer winner, in fact – so I didn’t mind.

What I do mind, and find to be absolutely incredible, is one of the statistics the author quotes within the first few pages. I’ve referred before to the fact that one in eight women will get breast cancer in her lifetime – a fact I couldn’t believe when I first heard it – but Mukherjee’s statistic is worse, much worse.

One in two men and one in three women will get cancer in their lifetime.

There’s really nothing more to say.

Cancer Lesson #37: The Cost of Keeping A Breast

Cancer Lesson #37: The Cost of Keeping A Breast

When I got the bill for my new girl, I found the insurance company’s specificity on what they would and would not pay rather amusing.

Plastic surgeon’s bill $11,052 minus insurance payment $2,738.44 minus insurance adjustment $8,052.11 equals $261.45 that I had to pay.

What I don’t understand is the adjustment thing. Does the doctor really agree to take $8,000(!) off the original bill? So, $261.45 – my new breast would have been a bargain at ten times the price.

Cancer Lesson #36: Why Did My Body Try to Kill Me?


Cancer Lesson #36: Why did my body try to kill me?

One of those “pink ribbon” stores sells a bag that says, “Of course, they’re fake. My real ones tried to kill me.” That’s what cancer is, you know, “…diseases in which abnormal cells divide without control and are able to invade other tissues.” (Definition from National Institute of Health, if you’d like the rest of the explanation.)

Basically, some of my own cells turned traitor and began pillaging their neighbors. As if in a miniature Middle East, these terrorist cells attacked whatever got in their way, leaving a trail of waste and destruction in their wake. When the lymph system (a body’s National Guard) stepped in, the renegades went after it as well.

You’d think all that annihilation would – I don’t know – maybe hurt a little? But I felt fine, even after finding my lump (home base of the mutiny). A little worried, maybe, but there was no pain except for the bruising needle jabs necessary for the seemingly endless tests (see Cancer Lesson #13). After an ultrasound revealed two other masses, all three were biopsied.

Lump #1 was cancerous. Lump #2 proved to be a lymph node the outlaws had penetrated. And physically I still felt great.  Oh, sure, there was that queasy feeling in the pit of my stomach when I realized what was coming, and I was relieved to learn Lump #3 was nothing but fibrous tissue. But there was no “discomfort” (as those in the medical field like to call it).

However, the rebel cells, my rebel cells – those dirty, rotten traitors – had to be killed. Left to their own devices, they would surely kill me. A surgical strike was needed to cleanly incise the insurgents. As part of that same surgery (let’s call it “Operation Bodacious”), I chose to have some new neighbors moved into the vacancy the renegades left behind.

Six weeks later, the “new neighbors” (tissue from my stomach, which had “population” to spare) had settled in. With my wounds healing, it was time to bring in the big guns: chemotherapy drugs. These medicines are meant to demolish any sleeper cells the ungrateful rebels left behind, and like all military strikes, they take out innocent bystanders (hair and white blood cells). They would wreak more havoc on my body than the disease had been able to.

Still, I chose to go through the chemo regimen because I don’t want to have to have to go through cancer treatment again. This is especially important because I’ve learned that, unlike most other cancers – where patients are considered cured after five years without recurrence – breast cancer cells can lay dormant for a long time. No one knows how they do it, but they do.

There are no guarantees in cancer treatment, just as there are no guarantees in life, but chemo and hormone inhibitors will raise the odds in my favor. Kind of luck buckling a seatbelt to improve your chances of surviving a car accident. In this case, the seatbelt was drugs so potent I was warned to call the nurse if any dropped on my skin,  and the possible accident is another round of breast cancer.

I called this one “Operation Stayin’ Alive.”

Cancer Lesson #29: Feeling Drained

Cancer Lesson #29: Feeling Drained

I was discharged from the hospital with a stunning new stomach scar – a good twelve inches long – and a belly button that had been relocated several inches above its previous position. It now looked like a bull’s-eye, surrounded by a circular scar.

The Engineer insisted the surgeons had created a new one, but I knew they hadn’t. That navel was the one I’d been gazing at all my life, a fact later confirmed by Dr. K2’s most senior intern.

Of course, I also had several smaller scars on my breast, and four tiny incisions for the tubes which led to the drains hanging from my stomach truss.

The Engineer and I were taught how to drain these receptacles several times a day, carefully measuring the liquid before dumping it in the toilet. This also involved – for lack of a better word – milking the tube to rid it of any icky bits that might cause blockage.

“You look like a suicide bomber,” said my ever-supportive husband.

Yes, dear reader, the plastic drains looked like grenades.

I viewed them differently. To me,  they resembled an udder dangling between my Velcro Granny bra and matching support Granny panties. No wonder I felt like a cow — simply bovine, my darlings, simply bovine.

But I was going home.


Cancer Lesson #26: “Wanna see my new boob?”

Cancer Lesson #25: “Wanna see my new boob?”

Sometime during the first night after my surgery, the hospital resident on duty stopped to check in on how I was doing. He asked if I’d looked at my reconstruction yet.

It hadn’t occurred to me, not because I had any reservations about doing so, but because only one activity held any attraction, and that was sleep, sleep, and sleep some more.

Still, I couldn’t help sneaking a peek when he removed my big, ugly, white, Velcro-closed bra.

I had a new breast.

If I squinted hard and used my imagination, it sort of looked like my old one, despite the stitches, and the tubes coming out of my flesh. Dr. K2 had even made me a new “nipple,” something normally done later as outpatient surgery.

I felt somehow comforted by the fact that I still had something to put into my bra. Even if it was a big, ugly and white  with Velcro closures.

When my husband happened to come in as Dr. K2 was examining his work, I asked him if he wanted to take a look.

“Wanna see my new boob?” The doc repeated my words with a laugh.

The Engineer merely shrugged and moved closer to study my new breast. He may even have said something about it looking pretty good.

Engineers are like that. Nothing seems to faze them.

Addendum: I came across this video from a CBS news report on the breast reconstruction. They cite some interesting statistics and facts.

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:

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.