This week, as you may have gathered from my highly unoriginal post title, has been CRAZY. Monday was the first day of classes, so of course things at work have gone into high gear overnight. Meanwhile, I had to be out three afternoons in a row for doctor consults or other health-related stuff, grrrrrrr!
Monday: Met with Dr. Brian again, mainly just so we could go over all the scan results face to face and have all of our remaining questions answered. Here's what we asked and what she said:
Am I likely to have to have chemo? It depends on the pathology reports on the sentinel lymph node and the tumor itself; these reports should be back two days after surgery.
How long will I be in the hospital? Usually two nights, sometimes one less, sometimes one more; it all depends on how quickly I recover.
If lymph nodes are involved, does that mean another surgery? Yes, it would mean another surgery, probably after two weeks or so.
Does my cancer have hormone receptors? Yes.
What does that mean? And how will it be treated? It means that the cancer cells I have love estrogen; each cell has a little place in it for estrogen to come and set up house and make more baby cancer cells. I will be given a drug called Tamoxifen that fools the cancer cells. Basically, the drug mimics estrogen and thus blocks the actual estrogen in my body from moving in with the cancer and helping it to spread. I will be on Tamoxifen for the next five years, at least. You can read more about it here, if you wish.
We talked more about genetic testing for the BRCA abnormality, which I had refused at first (since I have no daughters, and my sisters are dead), but after I thought about it, I decided it might be worth considering. I do, after all, still have one breast that is unaffected. Dr. Brian told us that if I don't have the genetic abnormality, the likelihood that I will get cancer in the other breast is less than 10%. If I do have the abnormality, the chance goes up to 56% to 87%. Also, without the abnormality, chances of ovarian cancer are less than 2%; with it, they are 27% to 44%.
I have to ask Dr. Brian one last time whether she is absolutely sure about the necessity of a mastectomy, whether there is any chance for any other resolution. She says, of course, yes, she is sure, and no, there's nothing else to be done. Nothing effective and safe, anyway. So I tell her that we can go ahead and schedule it, as well as the reconstruction. My surgery will take place next Wednesday, September 2, starting at 9:15. The mastectomy will likely take around 75 minutes, and the placement of the tissue expander takes about the same amount of time; Dr. Brian and Dr. Heistein will come out after each of their jobs is done to let Kyle know how I am. I will be in recovery for about an hour, and then Kyle will be able to see me. I will tell him to be sure to post here as soon as possible after surgery so that you can know how I'm doing, too.
Tuesday: Meet with the genetic testing counselor, who is a physician's assistant for Dr. Krakow (the oncologist who is part of Dr. Brian's practice). She is very thorough, explaining in great detail what I posted above and much more, for about an hour. They then draw blood, which is sent off to a genetic testing lab. $3200 and two weeks later, I will know whether I have the BRCA abnormality.
Also meet again with Dr. Brian, briefly. I think I mentioned before that at the very beginning of all this mess, Dr. Rice found a lump in my right breast. Well, that was a cyst, and it's never bothered me before, but last week it really started hurting. So Dr. Brian aspirates it very quickly and painlessly; the only part that hurts is the shot to numb my breast. It's over in less than five minutes.
We then meet with Kelly, the patient facilitator, again. She is SO NICE! I ask her lots of questions. I thought I had asked all the questions I needed to ask the day before with Dr. Brian. But we came up with so many more. And although I'm still very scared, I feel like I understand better what's going to happen to me, which helps to alleviate the fear somewhat. If you are squeamish, you may want to skip the next parts.
GROSS SURGERY DESCRIPTION ALERT!
For my procedure, a simple, skin-saving mastectomy, Dr. Brian will make an incision all the way around my areola and remove the nipple (sob!!!), then remove all the actual breast tissue. I will have a horizontal closure right in the front of what used to be my breast, about 2-3 inches long. She will make another longish incision under my left armpit and will inject my lymph nodes with a blue dye. As soon as she sees the first node turn blue, she will know that's the sentinel node and will remove only that one for analysis. Dr. Heistein will come in and use a retractor to separate the muscles of my chest wall from my ribs, making a pocket for the tissue expander, which is kind of like a very tough balloon. He will not have to cut the muscles, however, and the muscles will hold the expander in place. There will be no external sutures, and the internal ones will dissolve. A long, flexible tube with holes in it will be placed under where my breast used to be. This tube will extend outside my body and will feed into a closed suction ball, which will collect the fluid that my body will naturally produce in reaction to the trauma. I will have to keep this drain for a week to 10 days, emptying the suction ball twice daily and measuring the amount of fluid so that the docs will know that my body is slowing production of it, which means I'm healing.
GROSS SURGERY DESCRIPTION OVER!
I'm told that afterward, there is really very little pain from the mastectomy. Most is from the tissue expander placement. Kelly says that many describe it as being like a charlie horse in your leg, very, very tight-muscle feeling, but in your chest, obviously. She didn't say how it felt to her. I will have a morphine pump for the first 24 hours or so after surgery. They will then wean me from that and get me on to oral pain meds and muscle relaxers. The only oral pain pill that I've ever been able to take that didn't make me vomit (violently and repeatedly) is Darvocet. Unfortunately, it's a pretty sucky-ass painkiller, nothing compared with, say, Percodan or Vicodin. Kelly says that if one Darvocet doesn't do it for me, maybe they will let me have two. I'm freaking out.
When I come home, I am not allowed to take a bath or a shower the whole time the drain is in. A week to 10 days. Kelly says I can have a sponge bath, and Kyle can wash my hair in the kitchen sink if we are very, very careful. But that's it. I'm not allowed to do anything at all. No laundry, no dishes, no housework of any kind. I can't lift my arms above my shoulders. We have to be extremely careful because if I'm woozy and start to fall and Kyle grabs my arms, he will likely rip open incisions.
Kelly spends about an hour going over and over all of this with us. She is extremely sympathetic when I start crying again; she explains that it is part of the grieving process. She asks us about 15 times if we have any more questions. We come up with a lot but finally can think of no more. In the small meeting room where we are, there is a box with a bunch of heart-shaped pillows in the corner. She tells me to pick one out; they give one to each patient to use as a cushion between her newly mastectomied chest and the seat belts of cars. She says it's also very nice to use right after surgery, to tuck under the arm that has the incision. I pick out a navy-blue pillow with a small cream-colored kind-of fleur de lys pattern. It has a note on it that says, "Made 4 U with LOVE by Hannah, Age 15." Kelly tells us that girls at a local church make them. I think to myself, I never thought I'd be the kind of person to receive a handmade, heart-shaped pillow from a 15-year-old, church-going girl named Hannah. Well, thank you, Hannah, wherever you are.
Wednesday: On Tuesday, I got a call from the hospital where my surgery will take place, kind of a pre-op interview about my health history. When they found out that I smoked for more than 20 years, they said I'd have to come in for an EKG. GRRRRRRR. OK, well, that one's my fault. So I had to take YET MORE time away from work to drive 22 miles north of my campus to Harris Methodist Southlake. It took me 30 minutes to get there, 15 minutes to get checked in, and about 15 seconds for the EKG, which was fine, of course. The hospital is really beautiful, looks more like a spa. I saw some photos of the patient rooms, and they look like hotel rooms. There will be a bed and lounge chair there for Kyle, and they have wi-fi, so Kyle can bring my laptop to amuse himself while he's watching over me. By the time I'm done at the hospital, it's 5:00, so I hit bad rush-hour traffic on the way home. I was going to go back to work for a while, but after sitting on 360 southbound for 20 minutes and going about 2 miles, I decide to get the hell out of there and head home.
So that's it. No more consults or scans or tests before Wednesday. I have the next week, well less now, to get done everything I need to do before I won't be able to do anything at all for a while. My days are filled with frantic, nervous action, punctuated by staring into space and thinking about HOW MUCH I DO NOT WANT TO DO ANY OF THIS. Sometimes those thoughts catch up with me and I cry. A lot. But not too often. I think my heart-shaped pillow and I are going to become very good friends.
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