This was the plan:
Do radiation, or not-- the rest of the plan was the main focus anyway. For the next 3-4 months, rebuild my body to resemble former self. I was going to achieve this by mostly strength training with little cardio (I want to have my muscles back but can't lose much fat from my abdomen as it is needed to make a left breast mound in reconstruction), getting back to my high-fiber, high-iron veggieful diet to assist in rebuilding my white blood cell count, and skiing my ass off as I very well should.
I figured that with a little luck, I could be ready for reconstructive surgery by late January (I was planning on recovering levels faster than their projections as has been my usual throughout treatment) and be all healed up and ready for a normal summer job, something that got me back into my passions and had a splash of adventure to it, like going back to guiding, maybe going to Alaska to work for GOAK or doing an internship in Ecuador, or something. I had also been fantasizing for months about being able to kick my own ass going through the Insanity Challenge and become the most fit I've ever been and be in my physical prime at age 25. Then back to school in the fall-- YEAH!!
Oh how I loved that plan. Too bad.
This is the reality:
Radiation is still completely up in the air. Because of my age, my radiologist was reluctant to give a solid suggestion either for or against. There is always a chance of a second, localized occurrence, meaning I would get cancer again in my left breast tissue or the like, underneath my newly reconstructed breast. That could happen at any point in my life and is the reason why I would undergo radiation in the first place, in the hopes of preventing it. I am at higher risk for a second occurrence because I am HER2 positive (most aggressive form of breast cancer I could have), as well as estrogen and progesterone receptor positive, and I had node-positive cancer (even though I was only positive in 2 out of 21 lymph nodes, it stills ups the ante), and one of my nodes had mutated a little bit, changing shape and extending out into the surrounding tissue, which is apparently not a good thing.
Radiation can also cause cancer, thyroid or throat cancer being most likely because of the area they will be radiating, but it could come back as any kind of cancer as the cells gradually mutate over time. Normally, people who develop a second malignancy (radiation induced cancer) develop it 20-30 years down the road. This is why, when it comes to a patient in their 60's or 70's, radiation is much more readily suggested-- in 20-30 years, this person may not care so much about getting cancer again. But for me, that would place me in my 40's-50's, yet again battling cancer.
There is a breast conference of some sort going on for physicians in SLC right now. My radiologist is going to present my case before a board there and gather multiple opinions. This was excellent news! Not only do I get a second opinion, but a third, fourth and so on from some of the leading physicians in the country, all free!! That part, at least, is awesome.
Radiation aside, reconstruction does not quite look like what I thought it would. Dr. Chen thinks I may be ready for reconstruction in late January, provided I don't go through radiation. She also told me that, no, I would
not be doing reconstruction in one surgery, but possibly several. First, I would do the tummy-tuck and creation of the left breast mound. This surgery will take 6 hours. It also does not include any work on the right breast. This was news to me. Although it had never been discussed, I assumed that I would get the left breast rebuilt and the right one lifted and reshaped all in one surgery. While this is possible, it's highly dangerous because the right breast work will take a couple of hours and potential complications with circulation are a big deal.She has to cut through blood vessels on my tummy and sew them into blood vessels in my left breast area. If, for whatever reason, the tissue does not take and receive adequate blood supply after the surgery, the tissue will die. She will cut off all of the work she just did, leaving me flat chested and flat stomached, I'll recover for a few months, and then we'll reformulate a plan from there. Options for reconstructing a breast at that point would include taking a skin flap from the flank of my ass or my back, over one of my latisimus dorsi. All of these quite unpleasant and frightening outcomes are the reason she is reluctant to tack on that extra two hours during the surgery-- it allows that much more time for something to go wrong.
Directly after the surgery, I will stay in the hospital for three days so that she can monitor my circulation, looking for contusion or necrosis (I cannot explain how effing terrifying it is to imagine a half-moon shaped section of skin on my new breast growing grey and dying before my eyes). I will have three drains after this surgery, one out of the side of the breast like before and two out of an area of my selection for the abdominal incision. I can have the drains come out on the sides of the incision on my hips, but that could pucker the ends of my hip-to-hip scar and make them look like little dog ears, or I could have them come out of the pubic mound. She says most women go with the pubic area because you can easily hide the vampire-bite-like scars with pubic hair. Not too sure I'm into that.
The right breast won't come into play until at least 3 months after the first reconstructive surgery, when all of the swelling and settling has finished with the left breast. She will then lift and shape the right to match the left. And, again, I'll have 1-2 more drains coming out of the right side for another 2-6 weeks. Then, when the right side is all healed up (another 3 months), she'll create a nipple for the left side to match where the right has settled. I also have the option of having the created nipple tattooed to match the areola of the right side, but I don't know if I want that yet. Depending on how the left ends up looking, I was just going to cover the whole damn thing with a huge tattoo...so....yeah....we'll see. Btw, this is not the tattoo I want, it's just to give you an idea.
I'm frustrated with myself for making plans that I'm now having a hard time letting go of. It's my own fault, really-- that's what I get for assuming. Oddly, I'm not upset about the prospect of getting another 3 surgeries, making it 7 major surgeries in the span of a year. I'm sad about not being able to get back into shape and prove to myself that I can still be as strong as I ever was, if not stronger.
It's been difficult for me to watch as my body becomes softer and softer, wider and doughier. I know that I'm still stronger than most women who work out regularly. I know that, even if I worked out steadily for 3 weeks, I could still ski, row, climb and hike at almost the capacity I was managing pre-cancer. And yet, I do not feel as strong as I used to. I feel like a patient.
Being a patient brings on feels of obligation, disappointment, uncertainty, anxiety, apathy, frustration and sadness, and I'm slowly becoming tired of it. I miss feeling like me: strong, confident, funny, intelligent, beautiful and, in some ways, unstoppable. I still believe I am all those things (except perhaps unstoppable considering I'm quite thoroughly on pause), but there are some days that I just don't feel it like I used to, you know? That's the worst part about being a patient: losing my sense of identity in the wash of it all.
However, I have gained more than I've lost as far as beliefs about myself go. I am happy with how I've handled diagnosis and treatment, I've tried hard to stay level-headed and objective (as weird as that is) and I think I've done well with that. I'm also happy with what I've been able to do for others just by doing for myself; I'm not sure if people are just being nice when they say that I inspire them, but it seems sincere in most cases and the cases are many. Overall, I think that given what I was given, I've done far more than I could have done with it and I've taken care of my Pilsbury little self and kept quite happy through surrounding myself with friends, continually learning new skills or honing old ones, and exercising when and how I could.
But it doesn't feel like enough. I want to be free.
Blah....I just read over all I have written and I'm somewhat disappointed with myself. I wanted to not complain about my situation, as much as I could muster-- I often don't like when people do that. I only just came back from my doctor's appointment, so it makes sense that I'd be stewing about the insignificant....but it felt more than momentary, that's why I thought it deserved to be written. The truth of it is, I'm still a lucky, happy little duck with so many great things going for me: I'm just readjusting my plans.
On a much, much more inspiring note: it just snowed 8 inches at Alta with another 2-4 expected by Wednesday evening. I also have a Solitude pass, just Tuesdays so far but I have big plans of adding days. I just sold my car to Sean and had originally planned to hack off a huge chunk of a bill, then buy a bicycle so I can still get around. Now I'm thinking, forget the bike til spring and spend that extra on Monday, Wednesday and Thursday at Solitude. I mean, they open on Friday, and I do so love near-instant gratification.... :D
Hope you are all enjoying the weather, if you're lucky enough to have it.
Love.
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