Monday, August 29, 2011

Mammarian Ponderings.

Surgery to remove my cancer-ridden, left breast was pending. So what do you do to send off a breast? I was thinking there should be some sort of ritual or ceremony. However, given my lack of time and resources I had to keep it simple. So in an attempt to immortalize good old lefty, I scheduled a family photo. We hired a photographer to come to Coloma and do our Christmas shot. I envision myself lopsided, bald and pale by the time Christmas rolls around. Better to put my summertime tan to good use now and take advantage of my looking fabulous. Recently, we watched an episode of Modern Family where Claire, the suburban mother of three, requires the entire family to wear white. It was a funny episode. My family resisted but ultimately they were all psyched that I insisted. With a river back drop and the gorgeous bamboo gardens of a close friend, we rocked the backdrop in our all white ensembles. I got lefty forever recorded on digital film. It's all good. I still didn't think I was going to miss my left breast for anything other than filling the left cup of all of my bras. It barely did that anyway. I was looking forward to less bounce with running and jumping, and kayak gear sliding on a little easier. It seemed there were more pros than cons.
I was feeling pretty confident about my surgery. I hand-picked the surgeon, the scrub nurse, the anesthesiologist, the circulating nurse, the intake nurse and my recovery room nurse. No stone was left unturned. My last will and testament was signed and witnessed. The refrigerator was stocked east coast hurricane style and my husband was off work. We were all ready to go. I tried to get sentimental about lefty, but was having trouble. After all, it sort of let me down by letting cancer get a foothold. I'm anticipating no love lost. Not sure if I'm being callous or not. It is what it is.
How does one envision themselves without a breast? It's a weird sort of thing. I've tried moving lefty around so it looks like I don't have one. Seems even more convenient. I can't help but wonder if I should just have the right one removed too. No bras, no more cold nipples, and I can do the sports guy chest bump.
Still, just in case I miss the thing, I took pictures, with and without clothes. Of course, I did the naked ones myself. No use in torturing an unsuspecting photographer with such a task. Being an ER nurse, no gesture is too morbid but sometimes the outside world sees things a little differently. With photos, I can remember the left breast that once was.
Now the upside to all of this, is further down the road. I will have an opportunity to rebuild. Yes Ladies and Gentlemen, my future could hold a boob job. Not just a little old Masoplexy like I was planning with a nip here and a tuck there, but a full blown surgical recreation of my femininity. I'm thinking the round kind that does not move and stands at attention like a group of graduating navy seals. The irony is I think my girlfriends and my husband are more excited by this prospect than I am. People are already planning "pick Tori's rack" parties. Marek had an in-depth discussion with my primary care physician about the endless possibilities which was a little strange.....I was sitting right there while they were discussing my future bra fillings. I suppose I have to really decide whether or not I want to bother. I'd hate to disappoint my posse, and I'd also hate for my husband to miss out on a golden opportunity. But my breasts have done what they came to do. They snared a man, fed my children and filled out some nice strapless dresses. But as gravity takes its toll, they lose their desireability and become more of a nuisance. Life without them might be better for my other structures like my new hip and my lower back. What to do....? This is likely a decision I will not make over a latte. That is probably why they do the mastectomy first. So one will spend months of chemo prioritizing what boobs mean to a woman in the first place.

Wednesday, August 24, 2011

My Peach Pit

"Tori, I don't want to tell you this but your results came back positive for cancer."
Cancer. Gulp. Don't panic, I thought.
Cancer...........Gulp.
Now what? "We need to get you scheduled for a Breast MRI as soon as possible..." [And a pet scan, and a biopsy.....radiation.....chemo......] "I'll turn you over to Vicky, my nurse so we can get that going...."
Don't panic......Did he really just tell me I have cancer?
It all started when I found a lump in my armpit about the size of a peach pit while I was at my daughter's soccer practice. It was hard and when I pushed on it, it didn't hurt. It was a Friday. I called my Primary Care Physician immediately but I knew he would not be in. Instead, I settled for the only available appointment in 3 hours with one of the Nurse Practitioners. She was condescending. "It's just a little 'ol inflamed node. Probably nothing to worry about." She ordered the mammogram and ultrasound anyway and a CBC to prove that my elevated white cell count would in fact support her findings. She did a full breast exam. She found nothing. 3 days later, my mammogram was negative, the CBC was normal (no systemic infection), and the radiologist couldn't make hide nor tail of the thing in my armpit. I made an appointment with my OB/GYN. After reviewing the mammogram and the ultrasound, she too, was of the camp that it was an inflamed node.
"but the CBC is negative," I told her, (indicating no systemic inflammation).
She did a full breast exam and again, found nothing but fibrous tissue. I've always had fibrous tissue which makes self exam difficult. She referred me to the surgeon, but before she did, she told me to wait a couple weeks. "See if it goes down in size. These things usually resolve on their own."
But after two weeks, the lump was still there. It moved but never hurt. It was hard and felt exactly like a peach pit. My armpit had an actual pit. There's irony for you. A few days later my Primary Physician called. He said he got the results of the ultrasound and that I needed to go see Dr. L, my first choice of surgeons. Luckily, it was my OB/GYN's first choice as well. I now had two referrals to the surgeon. It just so happens that he was also my first choice. He's pretty great. So two weeks later, I was in his office. He found my lump strange. Why such a big lump in the armpit and nothing palpable on a breast exam?
My thoughts drifted to the early mornings when my mother would drive me to early training. I was an alpine ski racer. She did the hard duty of getting me to physical conditioning training at 6 in the morning twice a week. However, the drive was 10-15 minutes from home and she would traditionally smoke all the way there. After 15 years of breathing her secondhand smoke, I was convinced that I now had lung cancer with metastasis to my lymph nodes. Lung cancer is the number one cancer of all of them. It's hideous and awful.
"Whaddya say we stick a needle in it?" Dr. L was suggesting a fine needle biopsy of my arm- Pit. It was the reason I was there.
"Let's do it." I said.
Four days later he was on the phone with the news.
Don't Panic I thought. Airway. Breathe. Years of ER nursing have taught me that panic is ineffective and not part of the algorithm that starts with the ABC's.....Airway, Breathing, Circulation.
I have been a registered nurse for 12 years. 10 of those years, I spent in the emergency department. I loved it there. Eventually, the 12-hour shifts were hard to do once I had kids. I took a position in the cardiac cath lab for two years, but the cath lab got busy and they wanted more of me than I was already spread too thin to give. I decided to give Oncology a try. For the last year, I have been immersing myself in learning about cancer, chemotherapy and how best to treat my patients. Just when things started getting interesting, I got cancer.
Dr. L's nurse called me back. " I have an appointment for a breast MRI on the 27th (9 days from now). Will that work for you?"
"Uh, no, I want one tomorrow."
"I thought you might say that. I'll call you back"
Two days after my conversation with Dr. L, I found myself face down in an MRI scanner. Let the games begin. For the next week, I would be subjected to every diagnostic test known to man. The MRI was loud and my nerves were rattled. Knowing I had Cancer, I was secretly hoping it was breast cancer since it's the most treatable. The MRI was a lesson in finding calm in chaos. My brain was racing with what-ifs while the knocking sound of the MRI tried to rattle me. I focused on my breathing until the radiology tech said, "Hold your breath please." I vowed that if I ever had to repeat that test, Valium would be a prerequisite.
From MRI, I would then go to Nuclear Medicine for a Pet Scan. The Pet Scan is a diagnostic exam where they inject a person with radioactive sugar. Cancer LOVES sugar. It absorbs it as fast as it can. This test had to be done another day because you have to fast for 6 hours and can't eat any sugar for the prior 24 hour period. Then, they inject you with the radioactive sugar. After letting it marinate for about an hour, I was moved to the nuclear medicine scanner and CT scanner. Here, they scan your entire body. The Nuclear Medicine scan picks up the location of the radioactive sugar while the CT scanner scans the image with respect to where it is in the human body. It's genius really. It's a long test but not nearly as bad as the MRI. It's relaxing, relatively quiet and the radioactive sugar doesn't do any harm. Plus, the Pet Scan tech had a little more personality, which is always helpful. Usually, they do the biospy of the breast and then send you for Pet Scan. However, with the timing, this worked out pretty well. I was off to my biopsy immediately afterward.
Dr. N. was very nice. First, the Ultrasound tech did an ultrasound of my breast. There they were, Tumor 1 and tumor 2, 1.7 and 1.5 centimeters respectively. Then, as I watched on ultrasound, Dr. N stuck a needle that resembled one of those automatic fire starters right into my breast and ultimately the tumor. I wanted it to scream, but I heard nothing. The needle was huge. Of course, I felt nothing because Dr. N was clearly very skilled at this procedure. He answered many of my questions and when they were done, I got a nifty little pink ice pack to tuck into my bra. It wasn't anything like the horror stories my patients told me. It was really quite easy. However, after being a human test subject with the prospect of Cancer being somewhere in my body, I was feeling like a lab rat.
Days later, my husband and I sat in Dr. L's office. The results of all 3 tests were in. I have (at least) stage II Metastatic Breast Cancer. The hormone results of the biopsy weren't quite back but based on size and spread, I was at least stage II. The pathology would grade and stage my cancer further but that took time. Time was now of the essence and we discussed lumpectomy vs. modified radical mastectomy. I was very pragmatic. I put my nurse hat on and discussed it like I discussed any other patient. We went through options, risks, benefits, etc. It was very obvious that the modified radical mastectomy with nodal dissection would be the answer.
My husband's face was pale. He didn't say much.
We would schedule the surgery for the following week. Too many weeks had passed and Cancer was just sitting in my body, growing and spreading. I needed it out. The chances for recurrence supposedly go down with full removal of the breast. Besides, I'm an A cup at best. Once they took out 3cm diameter of tissue, there was not going to be much left anyway and I wanted either a full, round-shaped breast or nothing, not some hunk of tissue that hung off my chest as an attempt to retain my feminine identity.
In a short time, I went from having my whole life in front of me, to being a cancer patient and scheduling the removal of my left breast. It was surreal. We didn't tell anyone. Primarily because we don't want the kids to worry. With a friend losing her battle with brain cancer and another friend battling Multiple Myeloma, my daughters equate the word cancer with death and loss. For as long as I can, I want to keep them cancer free, because for the rest of their lives, their Mom will have Cancer. They will find out soon enough. 2 extra months of a cancer-free childhood is a big deal. Let them live everyday as if Mom is going to live forever. For now, my husband and I are processing it as best as we can, doing what needs to be done and trying to get through to the final plan. I don't think losing my left breast will affect me. I don't tie my identity to my breasts nor do they enhance who I am. And given my small size, I'll bet no one even notices. Who knows how I will feel. I didn't miss my femur when they sawed it off and replaced it but then again, I'm not looking at the missing end everyday either. I'm more lamenting the fact that I will not be able to kayak anymore this season. Apparently, there's some rehab that follows and I won't be able to get in the river for awhile. Now, that is worth crying about. My friend's wedding is this weekend in Park City.I will see many old friends there and presume that there will be many happy reunions. It's probably a bad time to bring this up. I think I'll keep it to myself for awhile. Feels more manageable. As a self-proclaimed control freak, i was comfortable with keeping things under wraps. I was not naive enough to think that soon enough this would soon spiral out of control.

Saturday, August 20, 2011

My Friend Steph

My friend Stephanie is truly a damaged diva. Diagnosed with brain cancer, glioblastome (GBM) , a year and a half ago, she embodies a fighting spirit with grace and clarity. They found cancer in the other hemisphere of her brain recently and she has decided to stop therapy and live out the rest of her days with her family. I applaud her for this. Her hair has grown back. She does as much for herself as possible and she wrestles with the changes that take place daily as her brain shuts down non-priority functions.
I work as an oncology nurse now. I have seen the path of a GBM. It's about as hard as it gets. I am frequently torn about what information to provide friends in our community. I would like people to be informed and to prepare themselves, but at the same time, living in the moment, without dreading the future is a gift. I am tortured by the possibilities my friend Steph may face. I don't want my friends to know. I want them to believe in miracles and I want to be wrong about the outcome of this awful experience. What's also hard is there is no one to talk to about it. It's a weird problem to have. I can talk to fellow nurses and they understand, having been in similar situations with their friends or family. However, when your best friends are the ones you really connect with and they are the very people whom you no longer know how to talk to, it puts one in a very lonely place. It's almost a double private hell watching your friend deteriorate and not being able to talk to the people who can help you get through it. While many of our friends know and understand what is happening and are not naive to the outcome, the path Steph takes is still unknown. I now grieve for her husband, her mother, and her sons. I hope with all of my being that as her brain turns off the right functions first.
Being 44 is hard. It's no longer about weddings and new babies and job promotions. It's about divorces, ADHD and deaths of close friends. I can only imagine what 50 & 60 are like. Fortunately my own children are young so many of our daily experiences are about learning and growing and exploring still. Part of me feels like I am hiding behind this veil of my children's happiness while those around me face insurmountable obstacles. It's almost like I feel guilty for being happy and fortunate. It used to be that we all felt this way, and we reveled in it with happy hours, kayak safaris and transient personal interests as a community. Now, it seems that we isolate as families to protect ourselves from the tragic circumstances that surround us. Life is funny that way. Everyday I am grateful that my husband and I have jobs, that we can pay our mortgage and our bills. I am vigilant but grateful that my children do not have a diagnosed illness or that some psycho like Garrido has not ruined our lives. I am grateful for the small things at age 44, but I am suspicious that it's all too good to be true. Perhaps I have paid my dues enough by having a tragic end to skiing career, by being orphaned by selfish parents or for simply working hard everyday to be the best I can be. I hope this is enough as I am not sure if I can handle the physical and emotional challenges of friends around me. They all seem so much stronger.
As every damaged diva knows: That which does not kill us, makes us stronger. Steph is fortifying an army in our community. We are all stronger because of her.

Friday, August 19, 2011

Whoa, it's August

I had visions of grandeur of completing all of these great posts about my recovery. Once I started driving, I was then able to go to Physical Therapy appointments where Marion would gently remind me that I had a hip implant and couldn't run marathons anymore. I was always surprised that she had new exercises for me each week and my ego was slightly dented by the fact that I thought I was so good at this rehab stuff that I would challenge her to come up with something new. However, she is a phenom and understands me far too well. Most of her suggestions focused on finding peace with my implant, doing exercises that enhanced balance and equilibrium rather than repetitive motion that would wear down my new hip materials. I was as careful as I could be taking her recommendations as a subtle barrage on my unhealthy lifestyle and trying to reformulate the new, post-hip replacement me.
Since then, I have started riding my bicycle, kayaking with my kids and laying off the running and the soccer. I keep my scar out of the sun and visit my massage therapist, Alice Butler, regularly. I have reached the six month mark and magically, I feel almost normal. What remains is a stiff right hip. I can put my foot on my knee when I sit but laying my knee down in lotus position is a fleeting memory. I try anyway. I stretch, but not too hard and I try to keep myself from doing repetitive exercise that only beats down my joints. I am happy that I can sit in my kayak without pain. I've had some recent epiphanes about how I lived with pain and didn't even notice that I was modifying the way I live my life. I avoided stairs because it hurt so much. I realized this one day when I went up to my husband's office. Suddenly remembering I had forgotten something, I was overcome with a sense of dread of having to go down and back up the stairs again. When I tried to figure out why, I realized it was because I was anticipating the pain this short distance of stairs would cause. However, there was no pain and my sense of dread was merely a remnant of my behavioral modification for a painful hip. After this epiphane, I noticed other things I didn't want to do or would gracefully either delegate to my husband or sidestep entirely. At six months, now that I have strengthened and stretched my hip and regained my balance, I must now re-train my mind to accept a body without pain or fatigue. It's a new concept and yet another milestone in my new recovery.
I am happy to have my life back. While part of me feels a little like I "sold my soul to the devil" to have these pain-free years while my kids are young, I hope that medical technology catches up with my need for a revision or two over the rest of my lifetime. Although, I suppose it's presumptuous to assume I will live that long. After all, I could get hit by a bus tomorrow. All the better reason to have a pain-free hip and enjoy what days I have with my family.