For the Love of the Surreal Life

I'm trying so hard.

Ever since the unfortunately named Dr. Pennes walked into the ultrasound room and uttered, "You have a little bit of cancer," I've been steadfastly and happily planting myself in a surreal version of life.  It just hasn't seemed real.

               Little bit of ...

Didn't that use to be the name of a candy bar?  Right.  Bit O'Honey.  Instead of honey I've got a Bit O'Cancer. 

Just a bit ... but, well, yes, it's just a bit but see it's an ANGRY bit.  An angry bit of grade 3 triple negative, you see.  That's a bit of aggressive, that is ... just a bit of aggressive cancer.  Nothing to worry about.  Just a  ....

 .... what's that?  Oh ... yes, well, there are also a couple of "suspicious" areas on the outer sides of, well, of both breasts but ... MRIs can lie, don't you know.  Yes, they can show things that aren't actually cancer so don't you worry ... let's just stick a few more needles in and check, shall we?

Just a couple of needles

Here, get on your stomach again and, well, wait, we need to put another IV in so we can send that icy, stinging contrast through, the better to see the suspicious bits, you know.  Now hover and aim well, there you go, right into those two holes because that's the most comfortable thing in the world, isn't it.  Now hold still.

No, really ... you must NOT move.  We'll just roll you into the MRI tube and take a quick picture and, now don't move, roll you out and insert the needles, don't move, now roll you back into the tube for more images to make certain the needles are well placed and now roll you ... don't move ... out again and
                *BAM*           
                           take the biopsies.

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At least that is how I'm imagining it will be come tomorrow.  And, as you can probably tell, I'm writing this while Downton Abbey is playing in the background.  Just picture Mrs. Patmore and/or Mrs. Hughes saying the above and you'll see.

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And now surgery of some kind is on Friday, and I won't know what kind of surgery I'm having until Tuesday or Wednesday.  Is the cancer still believed to be an angry little dot on the upper inside of one breast?  Or will I find out it has spread throughout the breast or, perhaps, is represented in both. 

Or further.  Will it be found in my lymph nodes?

The surreal nature of this mayhem is finally cracking for me. 

And I don't like it one bit.

One angry little bit.

And Here's the Wind-up ...

I met with my surgeon today.  Colleen App - she's fabulous. 

I donned a floral cape (SO not a gown) and pretended to be an organic super-hero as she did an in-office ultrasound, comparing my various images with her own taken today, and clarified our plan for surgery.  What, when, where, how, expected outcome for the bosom. 

                        *slightly reddened cheeks*

I'm having surgery next week Friday, January 29th. 

What kind of surgery?  Good question.

That depends on the outcome of my two MRI-guided biopsies on Monday.  Beyond my tumor - located at 11 o'clock in my left breast - my breast MRI identified two other questionable areas, one in the lower outside quadrant of my left breast ... and one in the lower outside quadrant of my right.

You can imagine the concern, right?  One area of one breast vs the whole breast vs oh-crap-it's-in-BOTH-breasts.  The biopsies I'll have on Monday will answer that question.

So, come next Friday, early in the morning, I'll be headed into surgery.

If the biopsies are negative, I'll be getting a lumpectomy of my left breast with the surgical removal of several sentinel lymph nodes (to double check that they are clear for cancer).  It will take about 4 hours.

If the biopsies are positive for cancer, then Friday, I will be having surgery specifically to check my lymph nodes.  Are the sentinel lymph nodes - those nodes to first encounter fucked up breast cancer cells - clear?  If so, yay.  If not, if there is evidence of cancer in my sentinel lymph nodes, then they'll take all of them.  Then, a week or two later, I'll have a mastectomy, single or double depending on what's needed.

Oh, and there's a drain.  DRAIN.  Once they start taking lymph nodes, they'll need to insert a tube into ... well ... my underarm so that fluid that would normally drain out the lymph system can drain out the tube into, I swear to God, a clear grenade that I then empty as needed.  This continues over 5-7 days while, I guess, the area heals from the surgery.  It helps to prevent infection.

                           Yada yada yada.

I heard ... GRENADE filled with fluid from my body that I have to empty. And depending on whether cancer is found in my lymph nodes, I get to have this drain for 5-7 days or more AND learn all about what I would need to do to avoid .... conditions I hope to never need to explain to you without the benefit of wine.

But wait! There's more! Dr. App explained to me what she would do during a lumpectomy to make my left breast whole again.  She explained where the incisions would be made and how, once the tumor is removed, she would lift the breast, make it round and whole, and sit the nipple oh-so-perfectly on top.  A round breast with the nipple perfectly placed.

I'm 45 years old people.  What do you think my first thought was?

[Let me get this straight.  BEST case scenario is my left breast is cleansed of the cancer and basically reconstructed into round perfection then I undergo chemotherapy and radiation and, all that while, I have a perky left breast and my normal 45-year-old droopy ass right?  So, I'm short, bald from chemo, with a perky left breast and droopy right.  Gotcha.  Proceed.]

Would I forever has mismatched tits?

[Because that's the important question when fighting cancer but ... whatever.]

The answer, surprisingly, is no.  No, I will not.  Because the law, believe it or not, guarantees me a matching set.  At some point after all my treatment is done - after the chemo and after the radiation - a plastic surgeon will lift my right breast so that it matches the left!  How AWESOME is that!?

Random, unexpected, and awesome.

So, that's it.  Surgery on Friday  - one way or another.  Hope with me, if you will, that my biopsies are negative.  I'd really love to have my lumpectomy Friday and move on to the next step.

[I'm a bit skittish these days about hoping - it seems whatever I hope ends up a bit skewed.]

________

I had one last happy hour with some coworkers tonight.  Well, last for a few weeks anyway.  Obviously, next week, I'll be hopped up on painkillers post surgery.  The week after, who knows.  It was nice to sit and talk and listen to the odd cases.  To get a "cheers" to the surgery. 

In the midst, my little brother called me - not a usual thing - to apparently tell me about some depositions in a current case.  I took this to be code for ... "I want to call her, I'm not sure what to say about her boobs, so I'll talk work to really say I love her" ... see how I interpret?  It was sweet. 

Honestly, the most frightening part of today was going through the drive thru at Taco Bell tonight - which I do not typically do - and getting to the window with my exact change ready only to have the worker say my food was FREE because of the wait.

        Huh.  Taco Bell.  Free?

               What fucked up hell is THIS?

I'm not ready to die, dammit, it's just fucking breast cancer!!

________

And ... here's the pitch! 

A Plan. Of sorts.

I find myself wondering what to share here.  Do I share all?  Do I stay a bit vague on the details and only cover the main events?  Surgery, etc.?  There are benefits to both but, in the end, if someone stumbles upon this blog who is just beginning to fight breast cancer, I guess I'd rather them have my whole experience instead of a diluted version. 

So, here we are then.

After my initial diagnosis of breast cancer last week, I was referred to the Breast Cancer Multispecialty Team (MST) for treatment.  Frankly, I knew going into the appointments that my cancer is aggressive.  The pathology report for my biopsies finally posted early this morning and, so, I read it before going to the MST session.  If you're going through this right now, you'll have to decide for yourself whether or not you want to read reports before meeting with your doctors.  You know better than anyone else whether you'll benefit from it or be harmed. 

Don't listen to anyone else; make your own decision.

For me, if there is a chance it will be bad news, I'd like to read it, digest it, and perhaps get sick from it in private than sitting in front of another human being.  But that's me.

So I knew that my cancer is aggressive.  I joke that since I excel at so many things (Ha!), I should have expected my cancer to excel as well.  Now, I know my joking is a coping mechanism.  And I'll continue to joke for as long as possible.  Forgive me if it offends you.  But I really don't give a damn.

Because my cancer is aggressive, I'm on a priority list for surgery.  So my surgery will likely be within the next 2-3 weeks.  The grading of my cancer is a 3 on a scale of 1 to 3 with 1 being slightly abnormal and 3 being  ... really fucked up.  The pathology also tests whether the cancer is responsive to estrogen or progesterone.  If it is positive for that, then there are medications that have proven effective for helping fight against any reoccurrence.  Mine is negative for both.  Mine is also negative for a protein called HER2.  So my cancer is a triple negative invasive ductal carcinoma. 

Alas - this apparently is quite different than being a triple crown winner.  But, in a way, it is just another tool for the doctors to use to determine the best treatment. 

Which brings me to the plan:

This week, I'll be getting a chest x-ray, which is a fairly standard pre-operative test.  I'll also see my regular primary care doctor for pre-operative approval. 

Next week, I'll be getting at least two more biopsies.  I mentioned my pathology report above.  I also got the results of the lovely hang-loose breast MRI.  Along with measuring my tumor - it is anywhere between 11 and 15 mm depending on the test you read: the MRI has it at 13 mm - the MRI showed a questionable area immediately above my tumor that may be DCIS - ductal carcinoma in situs - basically, cells that would be invasive cancer IF they broke out of the duct.  It is sometimes called Stage 0 cancer.  The MRI also showed two small questionable areas on the bottom outside of both breasts. 

So, next Monday, I will be getting each of those two small areas biopsied.  If they come back negative for cancer - remember that MRIs can show things that look like cancer but are not - then I will be receiving a lumpectomy of my left breast, i.e., the surgeon will remove the tumor and a few lymph nodes (to double check those).  Before that surgery, the doctor wants a biopsy of that area above my tumor in order to determine exactly how much tissue needs to be removed.

If, however, those first two biopsies next week come back positive for cancer, I will be having a double mastectomy, the removal of both of my breasts.  Again, this would be due to the aggressiveness of my cancer so please, if you're just beginning to deal with your own, remember that everyone is different and many things go into the decision of how best to treat breast cancer.  All I can really say about this possibility is this: 

        If I'm to lose the ones I have, I expect the new ones to be SPECTACULAR. 

The actual surgery will likely be sometime during the first two weeks of February.  Up to two weeks of recovery is expected for a lumpectomy - and it would be outpatient surgery.  I'm not sure right now about the mastectomy recovery - I'll cross that bridge if it comes.

Roughly four weeks after the surgery, I'll be starting chemotherapy.  I'll have a port installed so that the drugs can be put directly into a larger artery and I'll receive it every other week.  The good news is that my oncologist strongly urges women getting this chemo to continue to work.  She does not expect me to have nausea or other issues that would impede me from doing so.  The bad news, or at least odd and surreal news, is that I WILL be bald.  Early on in the chemotherapy, my hair will fall out over a day or two - it happens quickly apparently - and I will then struggle not to call myself Gollum. 

Seriously.  Short, bald creature with large eyes.  Just call me Sméagol. 

Yep.

 My chemotherapy will last four to five months. 

And about two weeks after the last dose, I'll likely begin up to six weeks of radiation.  The radiation would take place at daily 15 minute appointments.  It is meant to make sure no stray cells of cancer remain and greatly lessens the chance of reoccurrence.

Regardless of what type of surgery I receive, the end result after chemotherapy and radiation will be this: 

My chance of reoccurrence will be between 4-6%.  When you consider that the chance of any woman in the U.S. developing breast cancer in her life is 12%, those odds sound pretty good. 

So, that's the plan.  I might be forgetting some specifics but, hey, it's been quite a day. 

Do me a favor if you've read this far.  Trust that I am strong.  Trust that I'll be fine.

I really am quite a bitch when I need to be.   

Make me laugh if you can.  It really is the best medicine.  Cause, hey, I'll be a hot mess of bald and boob jokes for most of 2016. 

In short, trust that I've got this.

10 Days

It took ten days for my calm to be truly damaged.

Ten days for a full-on break-down.

To find myself feeling real fear.

To sob.

To repeatedly murmur, "I'm going to be okay," like some goddamned psycho.

..........

This whole experience has remained largely surreal to me.  It's a bit like watching someone else's life.  Me?  I don't have breast cancer.  I mean, right, I do.  Right.  They've said that but ... it'll be fine.  It's just a little bit.  Of cancer.  Which by definition involves abnormal cell growth that invades other parts of your body.  And it's in me.  Right now.  Spreading.  Cells splitting into other fucked up cells. 

Inside me. 

I try to feel the tumor and I can't.  When would I have actually noticed this by touch?  How much farther along would it be had I waited another month or two or six to get a mammogram?  Shit, how much farther along will this be by Monday?  In another week?

One of my best friends is fighting this right now; has been for two years.  And her cancer is in various areas of her body.  I don't think I truly understood this aspect of it before.  And mine is (hopefully) very early and very treatable and, if the first doctor is correct, soon to be in my rear view mirror of life. 

I want it out now. 

I want it cut out NOW. 

Rear view mirror.  Right.  Screw seeing anything in the mirror.  Let's toss that shit out the car window, preferably as we're rounding a curve on a cliff and watch it tumble down hundreds of feet to explode into a giant ball of fire never to be seen again. 

...............

I'm no longer murmuring to myself.  [Good sign.]

I believe I'll feel better tomorrow. Of course, my stepmom will be here tomorrow.  The first of my family that I'll see in person after this whole mess started.  I'm a little worried about that.  Even with my break-down tonight, I'd like to keep the blubbering to a minimum and I've no idea how family in flesh will affect me.  I'm afraid it will make it even more real.

And I quite like the surreal, thank you.

I trust I'll feel better by Monday night.  Monday night there will be a plan.

Waiting really is the hardest part.  At least right now.

Just Hangin' Loose

Tonight was my breast MRI (magnetic resonance imaging) in preparation for my half day appointment with the Spectrum Health Breast Cancer Multispecialty Team (MST) at the Lemmen-Holton Cancer Pavilion next Monday.  [Oye, that's a mouth full.]

After my diagnosis, the people at Betty Ford referred me to the MST and they took over my tests and care.  From the surgeon through the oncologists on down to a "nurse navigator" and social worker, the MST will cover all the bases and help develop a plan for me moving forward.  [Seriously, check out the link above, it is a one-stop cancer care shop.]

My next step was the breast MRI, which will give a different picture of what is going on inside me.  When the nurse called to schedule it, she explained a bit of how it would be done, including that I'd be on my stomach for about 40 minutes.  Now, I don't know about you, but the thought of being on my stomach for breast imaging, smooshed up against a - what - glass table sounded terrible. 

Oh, was my image off.

And, oh, was it even more ridiculous.

The nurse explained that while I would be on my stomach during the test, the table had ... well ... two holes in it.  SERIOUSLY?  I took the nurse by surprise when I - the patient who recently learned she has breast cancer - could NOT stop laughing. 

Actually, I think she was getting annoyed because the giggles kept starting over.

Because I'm an adult with the occasional maturity level of a 12 year old boy. [No offense to 12 year old boys out there.]

I arrived tonight in full-on dread mode completely untempered by any happy hour drink because SOMEONE at MST told Olivia (the extremely pleasant administrative assistant there) that I could not have any.  Someone was wrong.  I asked upon arrival and I TOTALLY could have had a drink before slipping the ladies into two holes and hanging loose for 40 minutes. But I digress.

I arrived, slipped into one of the oh-so-sheek hospital gowns (open in front please) and sat while first Drew and then Kim patted, rubbed, and slapped my veins around in vain trying to find one for an IV.

I hate IVs.

My veins hate IVs. 

I'll give props to Kim, though. She only stuck me once.  Granted, it was a dreaded back-of-the-hand IV but it worked.  So, now I'm in hospital gown (open in front) with an IV on my right hand and am presented with ... the table:

See that slightly purple/lavender head/breast rest?  Yep.  With the open sides in case anyone needs to move anything around in there.  I spent 40 minutes with my girls hanging through those holes, my face resting in the deceptive 'you could be having a massage' holder, with my arms straight out in front of me, IV on top of the right hand, and a squishy ball in the left that would serve as my panic button should things get too intense for me during the procedure.

"What music would you like to listen to?"

Huh?

"What music would you like to listen to through the headphones?"

He should have asked what music would I want to hear set to loud buzzing and clicks but I appreciated it nonetheless.  [For the record, I heard some Struts, some Rixton, and, I believe, a Vamps song during my face-down time.] 

So, face down, arms overhead, headphones on, contrast pumping into my arm with both a sting and a chill, and praying that the panic ball would be unneeded, I proceeded to focus on my breathing for 40 minutes.  [Little bit claustrophobic over here.] 

And then it was done.  Up you go, out comes the IV, on goes a bandage, here are your clothes, and here's the door.  Wham, bam, thank ... you get the idea.

And now I wait. 

Monday afternoon will include individual appointments with three doctors - the surgeon, the medical oncologist, and the radiology oncologist - all of whom will give me a breast exam.  That will make roughly 9 people who will have felt me up in 2016 so far. 

Loose indeed.

Just A Little Bit ...

... of cancer.

I've sat here staring at the white page for a while now.  I'm not sure what to write.

But those were the words that turned everything surreal.

"Just a little bit of cancer." 

Less than a week out from my boring, smoosh 'em session, a nurse from Spectrum called to let me know that my mammogram showed some asymmetric tissue and they wanted me to come in for further images.  The next afternoon. 

No problem.  I know multiple people who have had to do the same. So, the next day, I again donned the stylish wrap half-gown (in plum this time) and allowed another stranger (extremely nice) to position my body and breast, and then I held my breath, and repeated the process several times.  The staff at the Betty Ford Breast Center in Grand Rapids are incredible.  And they don't send you home after taking a few images.  They have you wait while a doctor examines them in case more are needed.

More were needed.  So they took more.  And I waited.

The doctor requested ultrasounds of both breasts.  And, no, I didn't have to set up a new appointment and return again.  They did the ultrasounds while I was still there.  And the doctor reviewed them immediately as well.

I just wasn't expecting the results.  "Just a little bit of cancer." 

I had watched the screen as the technician tried to find the tiny spec showing up on the mammogram of my right breast.  She never did.  The report officially says my right breast is "unremarkable." 

                           Oh, if I had a nickel ....

She had then moved to my left breast.  My words a few seconds after she began, "Well ... that's a bit different."  Even I could see the black hole (at least that is what it looked like to me).  It's only 11 mm across.  Tiny, really.  Of course, it seemed massive on the screen. 

"Just a little bit of cancer."

So surreal.

It still is.

I'm not so much frightened as I am annoyed.  The doctor ordered a biopsy then went on to explain that the cancer is small - hence, "a little bit" - and immensely treatable.  I worried aloud about my Ireland trip in September (again, surreal), and he replied that, barring any unforeseen complications, he believes this will be in my "rearview mirror" by that time. 

Good. 

Okay. 

Right. 

Now what.

Oh, biopsy, right.  Let's schedule that.  Tomorrow morning? Let's do it.

So I returned to the Center Thursday morning where five core biopsies were taken from "the mass" and two from a suspicious looking lymph node under my left arm. 

Again, the people at Betty Ford are incredible.  I didn't feel a thing.  Actually, I found myself staring at the ceiling where some designer had installed a light panel that looks like a blue sky complete with a tree branch covered in blossoms.  Meanwhile, the doctor, nurse, and ultrasound technician all prepared me for the biopsies. 

"Does anyone here watch The Walking Dead?"  -- my all important question.

The answer was yes. 

                                "I'm just going to look at the flowers." 

     [Psst. Don't click that link unless you know what I'm talking about already 'cause SPOILERS.]

Chuckling from the watcher.

The area was numbed and then the doctor used ultrasound to guide her to the exact locations.  I heard several clicks as a hollowed needle took samples from the area but felt nothing.  Yay, Novocaine!

Then the waiting game began.  They had hoped that the results of the biopsies would be received in time to call me on Friday. 

They weren't. 

Hey, do you know what makes a winter storm weekend even longer?  Waiting for confirmation that you have breast cancer.

Just a little bit of breast cancer.

This afternoon, I finally received the call confirming it.  As in ... about an hour ago.  The good news is that the testing on my lymph node was negative! Yay!  The bad news is that I have cancer. 

Just a bit. 

Again, even with the diagnosis, I'm not scared; I'm annoyed.  And that's a good thing.  As they've told me, this is small, it is early, and extremely treatable.  And, it is small, it is early, and extremely treatable because I did not put off my mammogram any longer than I did.  I am so lucky. 

I am blessed by living in Grand Rapids with such easy access to the excellent nurses, doctors, and specialists at the Betty Ford Breast Center and Spectrum.  I am blessed to be catching this so early.  I am blessed to have excellent insurance.  I am blessed to be surrounded by incredibly supportive friends and coworkers.  And I am blessed to have family who are willing to drop anything if they are needed. 

So I am annoyed with just a little bit of cancer.  But I am blessed immeasurably more and look forward to the day I see this annoyance in my rearview mirror.



   





 

It's Squishing Time!

A few weeks ago, I realized that I've been neglecting some things in my life.  Beyond the Christmas tree that was never decorated, the Christmas cards that were never sent, and, oh, I don't know, THIS BLOG, I've neglected to get one of the most important yet standard tests a woman can get.

The almighty mammogram.

I can't imagine why. Honestly, who wouldn't want to strip from the waist up, sidle on up to a glass table and allow a stranger to manipulate "the ladies" into perfect positions before slowly lowering another glass slab on top of them, and squeezing until they've flattened out ... much like that marshmallow you squished last summer in between two graham crackers.

You are SO going to think of that the next time you bite into a s'more. 

And you're welcome.

Regardless, my doctor had ordered my usual squish-fest in the fall of 2014 around the time of my yearly physical.  I just never got around to scheduling it.  Oops.

Meh. So what, right?

You see, the thing is, that simple test is often the first indicator a woman will have that something isn't okay with the girls.  The melons.  The fat bags.  The ... eh, I'll leave the many humorous names for the LIFE-SUPPORTING mammary glands to you.  Feel free to comment.

According to the Centers for Disease Control and Prevention (CDC), cancer is the 2nd leading cause of death in women (right behind heart disease).  In 2013, cancer caused 21.5% of female deaths in the U.S.; cancer and heart disease combined caused nearly 44% of female deaths for that year while "unintentional injuries" caused only 3.8%.  But wait ... that's all ages, folks.

When you consider an age range beginning at 35 to 64, cancer reigns supreme as the leading cause of female deaths.  For 55-64 year old females, that percentage reaches 38.3% while heart disease rests in 2nd at 16.6%  Statistics can be frightening. 

Now, perhaps you're more Han-like and don't want to know the odds.  "Never tell me the odds!"

[Seriously, if you haven't seen Star Wars: The Force Awakens yet, stop everything, skip everything EXCEPT your mammogram and go see it. Now.]

The point is that anything you can do to keep yourself from adding to cancer's lead is important.  Finding breast cancer early reduces your risk of dying from the disease by 25-30%.  And mammograms are an important way of doing that.  The American Medical Association (and a whole long list of others) recommend that women begin getting yearly mammograms at the age of 40 (or earlier if you're considered high risk). 

So get to squishing, ladies! 

If you've never had a mammogram before, fear not.  My kidding above aside, the process is relatively quick and relatively painless.  You usually begin in a changing room where you'll be instructed to strip from the waist up and don a glorious wrap top (think hospital gown cut in half).  You'll also be asked to use a handy wipe to remove any deodorant.  Things like deodorant can show up on a mammogram and confuse the results.  The technician conducting the test will show you the machine and answer any questions you have before beginning.  While there is some positioning of body and breast, and your girls will be flattened, I have never found it to be painful.  The tech will position you, ask you to hold your breath, take the mammogram, and then have you relax while checking the image.  This happens several times in order to get as complete a view of each breast as possible.

That's it.  Yet, that little test could literally save your life.

I got mine on New Year's Eve. 

Start 2016 out by doing something simple to protect yourself. 

Get to squishing!