Meanwhile, In The Waiting Room

My surgery went by in the blink of an eye.  For me.  One minute, I was listening to my surgeon explain the plan to her team, the next, I was waking up in recovery and hearing the blessed news that my lymph nodes came back clear (90% sure so far of that).

For my family, however, my surgery took over four hours.  My Dad, stepmom, and two oldest sisters, Linda and Glenda, came to support me, and set up camp near the TV in the waiting room.  Fox News was playing.  And they stayed.  If that doesn't speak volumes of my family's love for me, nothing will.

A few hours into my surgery, Linda walked downstairs to get some food (a salad) and was returning when she noticed people leaving the building and overheard someone saying that it was being EVACUATED. 

She continued back to the waiting room .... and ate her salad.  [Of course, she did.]

Was this a drill?  Must be, right?  Regardless, my family's attitude was - "Sure, ya'll go ahead and leave but my (daughter, sister) is IN SURGERY right now so we're staying, thank you." 

They stayed until someone came and got them.  

I have this vision of my family being bodily dragged out, screaming to stay, struggling against security.  I'm positive that's exactly how it happened.  Yep.  Totally.

So, what happens in this situation?  Lights flashing and people told to leave when actual surgeries are taking place?  What mayhem is occurring when surgeons, elbow deep in blood and flesh, start hearing sirens and the call for evacuation? 

Um, nothing.  Apparently, the surgery calmly continues even if everything around it goes a bit nuts.  My family was told not to worry, that my surgery room had a fire wall or some such protection.  And soon they saw our fine Grand Rapids Fire Department arrive.

Adds a bit of excitement to an otherwise boring wait, don't you think?  When they were allowed back inside, all they know of what happened is that it was safe to be inside again ... except for a particular suite.  It's a bit of a mystery still.

But the real question remains.  WHAT effect would sirens and firetrucks, evacuations and flashing lights, have on my breast?! Because, you know, priorities.

I took a shower tonight and came face to breast with my Frankenboob.  Wow. 

The tumor was removed, breast tissue moved about, and things, um, relocated. Trauma with a capital T. 

She's going to be brilliant.  And no, there will not be a picture.

Alive, Drugged, and WITHOUT Armpit Drain!

Welcome to my hallucination. 

One month ago, I didn't have breast cancer.  Well, I didn't KNOW I have breast cancer.  Ignorance truly is bliss, isn't it?  But ignorance can be deadly as well.  Had I NOT went to my mammogram, had I put it off even several more months, I'd likely be facing a much different future.

My surgery was this morning.  My day began at 5 a.m. when Taylor Swift began yelling at me from my stepmom's phone to "shake it off."  Indeed.  By 6:30, I was entering the Spectrum's Lake Drive Surgical Center, signing in, signing off, and donning another medical wristband.  Soon, I was in Room 23, trading my clothes for a Bair Paws gown, hair cap, and purple Bair Paws socks.  The gown had holes in it and the nurse hooked a hose into one of those holes and gave me a small controller to adjust the temperature OF THE INSIDE OF MY GOWN.  How cool is THAT!?

Hell, even the IV went smoothly this time.

Dr. App [God bless this tiny marvel of a woman] arrived, met some of my family, then kicked them out so she could draw on me.  Literally.  It's an odd feeling to have someone draw on you, saying things like, "And here's where we're going to put your nipple."  [Understatement.]  The anesthesiologist stopped by, other members of the surgical team said hello, and I was soon wheeled into the actual surgery room.  The last thing I remember is Dr. App talking to the team about who I am and what they'd be doing today.  The next thing I remember is coming to with the song, "I Want To Write You A Song," going through my head.

I felt some pain and some nausea.  I immediately directed my attention to my left arm, and realized I did NOT have tubing coming from it as I'd expected.  Then *cue CELEBRATION* the BEST NEWS EVER:

My sentinel lymph nodes showed no sign of cancer and a drain had not been necessary for the four they removed! The surgery was a complete success! 

LITERALLY, the best possible outcome [outside of the Dr. determining that the pathology report was incorrect and there's no cancer ANYWHERE.] 

I didn't stay too long in recovery.  I'm probably too proud of the fact that the unseen patients on either side of me were groaning and moaning and asking for more pain medication while my nurse latched onto a sigh, "You sighed - do you need more medication?"  Once back in my Room 23, they brought me a small banana muffin and water (and medication).  Maybe an hour later, I was headed home.

My surgery went wonderfully.  For me.  *cue CLIFFHANGER*

Did I mention the evacuation and firetruck?   


 

NO WHAMMIES!!!

Nope. None. Nada. 

We've got NO whammies here, ma'am!

               *dances silly jig*

I got the call earlier today.  A nurse from the Betty Ford Breast Cancer Center called to check up on how my night of iced boobs went following the afternoon of 13 biopsies.  The conversation went something like this:

-----

I have some questions to ask before we get to your pathology.  So how did last night go when you got home?

Pathology? You have the pathology?

Oh, yes, but there's a checklist here, we'll get to that.

*Me. Instantly thinking it must be bad news.*

So how did last night go?

Fine. All fine. I haven't taken pain pills since this morning.

Do you have bruising?

Not much.  It's fine.

Fever?

No.

Well, okay, good, just let us know [FOR THE LOVE OF GOD WOMAN TELL ME THE PATHOLOGY] if there are any changes or if you have any questions.

Of course, so you have the pathology?

Yes, let's see ... [YOU'RE KILLING ME, SMALLS!]

Okay, both areas biopsied have the same diagnosis.

*Me. Positive that she just told me that the biopsies have the same diagnosis as my tumor because OF COURSE THAT'S WHAT I'M GOING TO THINK HEARING THOSE WORDS!*

The same?

Yes blah blah blah benign blah blah blah blah

Wait, back up ... benign?!

Yes, no further cancer was shown.

*Silence as a wave of relief is crashing over me*

Kimberly?

*I finally get out*  I'm here.  Just a second.

Why do I always cry at GOOD news?!

Of course, dear.  Now blah blah blah blah blah medical terms blah call us if you have questions.


-------

And then I was back under control. 

None of the 13 biopsies yesterday showed any cancer cells!  Can I get a "Yay!!!!" - because I'm fairly certain all of my neighbors know I was flippin' happy for a while minute there.

So this means my surgery Friday will be a lumpectomy to remove the main tumor and removal of several sentinel lymph nodes to check those for cancer as well.  I will still have chemotherapy and radiation but the cancer has not spread to the rest of my left breast or to my right.  My next big hope is that the lymph nodes continue to be clear.

But for now - NO WHAMMIES! 

Living la Vida Ridicula

So, I'm just chilling here waiting for X-files to begin.  And by chilling, I mean literally icing down my boobs.  You? 

You remember way back on January 7th when I had biopsies done to confirm whether or not I had cancer?  Using an ultrasound, the doctor located the tumor and took five core biopsies of it and then two biopsies of a suspicious looking lymph node.  Tumor - cancer; lymph node - clear (yay!).  I remember thinking - wow - SEVEN biopsies!

This afternoon they took THIRTEEN more.  And these were done with the guidance of an MRI.  Remember my description of the odd hangin' loose breast MRI?  Ooh, and remember my s'more description of mammograms in general?  Just for fun, let's combine those two experiences, add some shots of Novocain, and a good-looking male doctor seeing you at your ABSOLUTE worst, shake it all up and see what we've got, shall we?

Oy vey.

My day began with a failed attempt to locate a suspicious area on the lower right side of my right breast using ultrasound.  No problem, I've been through the ultrasound process before during the initial diagnosis.  Except now we've got a male doctor at the helm and WHY does he have to be a good looking male doctor?  Seriously.  It's uncomfortable enough to be naked from the waist up, raise my arm up over my head and stare at the flowered ceiling panel while someone maneuvers the magic ultrasound wand around my breast through a grand dollop of gel  (a little dollop will NOT do in this case), without adding hottie to the mix, thank you VERY much.

Oh, you see nothing in the right breast?  I need an MRI-guided biopsy on that one, too?  Great.

YOU'RE doing the biopsies this afternoon on me?  Brilliant.

So, I returned this afternoon, donned scrubs with the handy wrap top, and prepared myself mentally for what I'd envisioned last night.  Yeeeeah ... close but no cigar.

They again tried in vain to find a vein and went for the back of my hand; my left hand this time.  The nurse tried three times in the back of that hand until she gave up when I started to pass out.  [Yeah, yeah, I'm a wimp.  You have someone stick a needle into the back of your hand and wiggled it around for a minute trying to stab the vein that is WISELY rolling away from it then get back with me.  Otherwise, shut the hell up.]  She apologized profusely, said we'd wait until I went down to the MRI room, and gave me a Band-Aid.


----------

This Band-Aid.

She left me to rest, I looked at that Band-Aid with one of my childhood loves on it, and couldn't help but think about my 5 year old self.  And, yeah ... that nearly did me in.  I'm fairly certain that 5 year old Kim never dreamed of any of this crap.  5 year old Kim simply wanted to eat Count Chocula and watch Bugs Bunny; well, she at least wanted to eat the marshmallows in the Count Chocula and watch Bugs Bunny. 

------------

A few minutes later, with dry eyes, I went down to the MRI room where another nurse found a deep vein in my right elbow region and managed to give me an IV without me feeling anything.  And we were off ... to a false start.  I'm back on the table, on my stomach, with the two holes, positioned as before but WAIT ... there's more this time.

This time we're combining the wonder of a mammogram with the absurdity of the MRI, so on either side of both breasts were plates that then squished the girls into two simultaneous downward hanging pancakes complete with grids on the outside to better mark the biopsy locations.

Yep.  My imagined "don't move" was there but with my boobs in two vices - like I COULD move - for about 15-20 minutes until the nurse came in to have me extradited from the contraption because the computer needed to be rebooted.

SERIOUSLY?! Another twenty or so minutes went by and it was time for a repositioning, re-squishing, and, this time, I was that way for over a half hour.  I was moved into and out of the MRI tube several times as images were taken, Novocain was administered, needles placed, checked, and then core biopsies were drilled out of me.

I say drilled because that's what it sounded like - a little drill.  I felt none of that (YAY Novocain!) but did wonder a bit at the number of whirring sounds.  I found out later that the doctor took 7 samples of the left breast and 6 of the right breast.  This information was provided to me after the compression was removed from my breasts only to be replaced by said doctor's hand on my right and a nurse's hand on my left, applying pressure to stop the bleeding.

So ... totally not awkward AT ALL. 

Then they asked me to get up so they could continue to apply pressure while I was sitting  Again, boobs out, hanging down, on my stomach, and I'm asked to do a kind of push up to lift myself out of the breast mobile.  Now, I'm 45 with a body that has gained and lost and gained and lost weight numerous times during my life. 

Trust me when I tell you that raising myself up from that position with those onlookers was more painful than those three attempts at an IV in the back of my hand that left me light-headed.  And then it was done.  Mostly.  And I'm home chilling.

And now we wait.  Results are expected sometime Wednesday and, as I explained before, those results will determine what type of surgery I'll be receiving on Friday.

I keep hearing echoes of "No whammies, no whammies!" in my head.  In this case, no whammies means negative results and a lumpectomy on Friday.

Whammies mean a lymph node surgery Friday (to check some and, if necessary, remove all of them) in preparation for a mastectomy at a date a week or so later. 

Whammies are bad. 

We don't want Whammies.

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.

------------------

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.

------------------


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.