Friday, April 29, 2011

Mind over matter

I only have 5 doses of radiation left.  Why do I feel so defeated?  Answers: 1) real, chemo-esque fatigue has set in; 2) I am entering week 3 of a sinus infection and I'm grumpy about it; 3) my throat is burned, making it painful to swallow and therefore difficult to stay nourished and hydrated.

Hmmm.  Justifying my depression doesn't make me feel any better.  To feel better, I am going to employ my tried and true methods of Indulging Myself and Mind over Matter.

1)  Indulge the fatigue.  It has gotten quite severe and can no longer be denied.  I don't know why it has gotten so bad; perhaps my low white counts are a contributing factor?  Below is a graph of my white counts that I snagged  from my electronic medical chart.  You can see that as of Wednesday (4/27) they have dippped down again, ending their brief upward trend.  The blue dashed lines show the normal range for white blood cell counts.

I went to work yesterday and tried to think, revealing my lacking cognitive abilities and exacerbating the fatigue.  Sigh.  Today I am resting, with the exception of this post and the two short walks to radiation.  I am going to lay on the couch or in bed, do some puzzles with the ladies, and read a delicious book.  I can't wait for all of this to be over so I can get back to my exciting science!

2)  The sinus infection is no doubt contributing to the fatigue, but mostly it is responsible for my grumpiness.  The endless drainage is getting old.  Yesterday I saw Dr. Ear Nose and Throat, who stuck a loooooong periscope followed by a loooooong Q-tip up my nose and took some samples.  These samples will be cultured for bacteria and fungi, and I will be given the appropriate antibiotic based on who has wrongfully colonized my sinuses.  In the meantime, he gave me a sinus wash that contains the antibiotic gentamycin.  I am to squirt 90 milliliters of this antibiotic solution up my nose twice per day, and he seems to have given me a lifetime supply (I think it's two liters).  This is certainly a situation in which I need mind over matter, because all of that fluid rushing through my head sort of feels like I'm drowning.  But I'm not.  So I close my eyes tightly, open my mouth wide, and squirt the solution up one nostril.  Gravity pulls it out of the other nostril almost instantly, and like a whale clearing its blow-hole I snort out the remaining fluid.  Yea.  Grumpy.  But it has to get better soon.

3)  The radiation is burning my esophagus and swallowing is painful.  Dr. Radiation Oncologist gave me some liquid tylenol with codeine, and that helps a little bit.  Also, I met with a dietitian to get some tips on what foods will feel better.  She said that water will be one of the most painful things, and it is.  She said to go for things with a little bit of thickness to them, but not too much texture.  For example, mashed potatoes, smoothies, cream of wheat, and ice cream.  These have all been excellent suggestions, and indeed I am a bit more comfortable at mealtimes eating mushy foods such as these.  Ice cream in particular is fantastic because the cold is a bit numbing.  Overcoming this problem is definitely a case of mind over matter because I have to stay hydrated in order to ease problems 1 and 2.  Grimace and take it down, hbomb.

I'll get a nice break from radiation over the weekend, and then I should finish up on Tuesday.  I'll definitely be weakly stumbling over this finish line.  No triumphant arms pumping the air.  At this rate I'll be lucky if I'm not crawling.  

Wednesday, April 27, 2011

Looking great in films

My problems are relatively unchanged from my last post:  I am still blowing massive snot wads, it is still cloudy, I still have cancer-itis.  It is strange to be in a static state for this long, but I suppose I shouldn't complain since nothing is that bad.  And things haven't been truly static.  The radiation is starting to give me esophageal burns, so that's a change.  It sort of feels like a perpetual lump in my throat, and it hurts to swallow hard or to swallow scratchy things, like toast.  Also, the skin that is being irradiated is quite pink, but that's all.  No blisters or anything yet.

Dr. Radiation Oncologist is quite pleased with the way my skin is holding up, and indeed with the way I am holding up.  He said that my "films [X-rays] have been incredible.  God, do I have to tell you that you're perfect?"  That was a lovely albeit unlikely compliment that day.  I never expected to be complimented on how I look in X-rays.  It's a handy thing to look good in, considering they see right through the sweatpants and baldness.

Today has been a medically busy day.  This morning I had my blood drawn, then radiation, then chemotherapy (triple-dose herceptin).  I reported to Dr. Oncologist about my epic and ongoing head cold, which resulted in a CT scan this afternoon to determine the magnitude to the probable sinus infection. In an hour I'll head back over for the second dose of radiation, and while I'm at the clinic I'll pop up to get the CT scan results from Dr. O.  I wonder if I look as fantastic in CT scans as I do in X-rays.  Maybe X-rays are more my "color".

It was a nice holiday weekend for me and the family.  The girls really enjoyed their Easter baskets and spending time with the extended family.  My dad rented a log splitter for the weekend, and so many of my relatives participated in seven hours of log splitting (aka earned their dinner).  It was certainly a new twist on the idea of "breaking bread together"--breaking logs together.  The amount of work accomplished was inspiring; maybe I'll host Easter next year and everyone can build me a garage.  Despite my teases, it was indeed a lovely day to be outside, and I'm sure we'll all contribute to the burning of the logs that were split.  Also, it was great to have the chance to "give back" to my dad, who has done so much, for so many, for so long.  Love you, dad.                        

Saturday, April 23, 2011

Patience and patients

I am so tired of being treated for cancer.  I know I'm almost done with all of the hardest stuff, but I'm finding it hard to be patient with being a patient.  It's a lot like senior-itis.  You know, the condition of senior-level students near the end of the semester when they just stop caring because in they're head they're already graduated.  Yep, I'm fighting the cancer-itis.  I go to radiation with a weary yet impatient sort of attitude, I often forget to put soothing ointment on my skin, and I'm doing my physical therapy half as often as I should.  In my mind I've already crossed the cancer finish-line, when in actuality I still have at least 6 months to go (1.5 weeks of radiation, possible right mastectomy, herceptin through October).

What is UP with THAT?  I should be doing a better job of taking care of myself.

Part of the problem is that I have had a horrific cold this week.  The magnitude of the cold is certainly related to the cancer treatment.  I'm usually the person who neither misses work nor medicates for a cold.  This was soooo not true this time.  The cold knocked me down and stomped on my head.  I asked Dr. Radiation Oncologist if I was more susceptible to the cold because of the radiation, and he said yes, plus my white counts are still low from chemo, plus I have two little kids, plus I'm working.  I was sheepish then and promised to go get some rest.  Thank you, Ian, for enabling some epic sleeping for this mom-scientist this week.

Also, the sun has not made an appearance in...2 weeks?  I've lost track.  My mood is not usually affected by prolonged cloud-cover, but in light of my patient-related difficulties I think the lack of sunshine is contributing to my cancer-itis.  I've lost patience with the gloom.

But at last the tables have turned!  I am delighted to report that 1) I have the upper hand on the cold, 2) the sun is out today, and 3) the Easter bunny is ready to dazzle and delight some special ladies this weekend!  I think I'll pack up my impatience, slip it in the Easter bunny's basket, and watch it hop away.  I have no use for it.  

Last night I had a dream that Azalea was wearing a light blue dress as she left the house, headed to prom.  Eleanor and I were standing shoulder-to-shoulder in the doorway, beaming at the grown princess, our heads touching.  Both girls, incidentally, were taller than me, which is to say Quite tall.  Despite the obvious connection between this vision and the home movie in my previous post, I say huzzah for visions of myself living for another 15 years.  Hopefully this vision will help remind me of the importance of staying focused throughout the remainder of my treatment regardless of the cancer-itis.  

Tuesday, April 19, 2011

Believe in things you don't understand

As I was hoping last week, I have indeed adjusted to this crazy radiation schedule.  It is not nearly as exhausting as it was last week, although I find it hard to believe that it's only been one week.  The electron doses started on Monday and just take an extra few minutes.  Well, the electron dose itself takes only ~20 seconds, but it takes a minute or two for the technicians to get things set up.  My skin is starting to turn a little bit pink, as predicted.  Still not red.  Still not sore.  Huzzah!

In other health-related news, I have 100% range of motion in my left arm.  It is not pain-free, in neither the nerves nor the muscles, so I will continue physical therapy for a bit.  I do my exercises every day, and I can feel improvement every day.  I've started to forget that I used to bump into a breast when I reached across my body.  I've even grown accustomed to the burning nerve pain in my arm.  It's sensitive, but not crippling.  Again, huzzah!

While I was getting zapped today, I was thinking about all of the particles that were poking through my skin.  I couldn't feel these particles, but I nonetheless thought of my poke tally.  Was there a way to calculate how many particles (photons or electrons) were "poking" me in a single dose of radiation?  So that I could start a particle poke tally?  I asked this question of one of the fabulous technicians, and she introduced me to the physicist.  He seemed delighted to talk shop with someone and explained that the radiation machine is calibrated by measuring how it ionizes a known amount of air.  This is then converted mathematically into the ionization of an amount of liquid, liquid being of interest because a human body is ~60% liquid (today mine is ~70% liquid due to the incredible amount of snot I'm producing; thank you sweet Eleanor for giving me your cold).  This is further converted to the unit Joules per gram, and he said from here we could calculate exactly how many Joules-per-gram of radiation I am receiving in a single dose.  It sounded like it would take a fair bit of effort on his part, and because this is an unnecessary exercise I said no thank you.  He further explained that the machine is tested every morning to see that it functions within good parameters, and if it ever falls out of those parameters he re-calibrates it with the air ionization thing.  He also said that he belongs to some Houston-based national radiation calibration organization and follows their calibration protocol annually.  I came away from the discussion with something much better than a particle poke tally:  confidence in the machine and the people running it.  But part of me still wants to know something quantitative about this radiation rather than the empirical "20 seconds of photons here, 10 seconds of photons there, and 20 seconds of electrons there."  It's a little hard for me to grasp, but I guess I'm just biased towards whole atoms.    

It has been a cold, rainy, sleety day here today.  To combat the cooped-up feeling, the girls and I had a disco dance party this evening.  Cinderella even made an appearance:

Pandora radio was our DJ, and one of the songs that popped up was Stevie Wonder's Superstition.  I know I've already posted a Stevie Wonder song, but this one really resonated with my thoughts after the discussion with the physicist today.  Radiation at times feels like it could be superstitious:  I lay there with my arms above my head while a machine waves an over-sized magic wand above my former cancer.  Bibbity bobbity ZAP! and the cancer is gone.  I know it's not superstition, however, and that's why I've found another connection between this song and radiation.  The clavinet riff, which is the song's trademark, sounds like the buzzing noise made by the radiation machine when it is zapping me.  I wish radiation were as funky as Stevie.  Below is the jam-session version of Superstition, performed on Sesame Street.  Smile.      

Saturday, April 16, 2011

Photons AND electrons

Before I tell you about my special radiation treatment that will begin on Monday, I want to update you on my hair growth.  This is something that many folks have been asking about.  I myself have been trying to ignore it because just as a watched pot never boils, a watched follicle never grows.  In other words, my hair growth is impressive to those that only see it once a week, but it seems dreadfully slow to me.  The good news is that it is long enough and my cowlick is severe enough that it's starting to lay down already.  Exhibit A:
Can you see the hair drifting to page left?  I don't think all of the follicles are firing yet, but the hair that is growing has a nice color.  Also, muchisimos gracias to Heather V-D for the new fancy robe that I'm sporting in the pic, aka right now, and for the chocolate in my belly.  Best care package ever.  

My radiation treatment is going to get a bit more complicated on Monday.  With the first real radiation treatment on Wednesday, one of the technicians drew the radiation field with a marker on my chest.  I have no idea why she did that, but it was great because this was the first time that I had a chance to see what the heck is getting radiated.  It's a huge area, but not huge enough.  It leaves out about two inches of my sternum-proximal incision, which out of principle is no big deal, but I happen to know that before chemotherapy there was a cancer-related rashy thing over there.  It took a bit of back-and-forth with Dr. Radiologist, but one of the technicians and I convinced him that it was important to treat that area.  I'm not trying to say that he didn't want to treat a place that used to have cancer.  What I mean is that 1) based on my chart his planned radiation therapy was perfectly targeting every place of documented cancer, and 2) his planned radiation therapy is perfectly avoiding my heart.  I had to whip out my right breast and show him exactly what the left breast looked like before chemotherapy to sufficiently explain to him that it's possible that the normal photon radiation could be missing a formerly cancerous region.  I told him that the chemotherapy eliminated the rashy sign of cancer, so I didn't mind not radiating that spot as long as it was medically unnecessary.  I also told him that since the mastectomy I actually have no idea where that portion of skin is now located, or if it's even still attached to me.  He said that he'd like to treat all of the skin that used to show cancer, he just didn't know there used to be cancer in that area.  It's a good thing I'm paying attention!  

Now that we were all on the same page, he and his crew spent Thursday and Friday developing a radiation therapy for that region.  They didn't want to adjust the regular, photon-based radiation because again, my heart is right beneath the former rashy spot.  Instead they are going to treat that region with electron radation.  Electrons don't penetrate the body as deeply as photons do, so the idea is that electron therapy for this above-the-sternum skin won't damage my heart.  The bad news is that electron therapy will make my skin angrier than the regular photon therapy.  The plan is therefore to pursue the electron therapy only until the skin gets good and red, which is a situation in which putative cancer cells are killed, and then we'll cease the electron therapy.  Sounds good to me.

My goodness it's hard to communicate with doctors sometimes, and I'm a doctor (of sorts) myself.              

Finally, I added a picture of our owl to the tats and zaps and hoots post.  I haven't seen the owl in a couple of days, but I've heard it in the neighborhood.  Hopefully it hasn't left us for good.

Thursday, April 14, 2011

Yet another brand of fatigue

This was my schedule today:

wake up
walk to radiation
walk home
drive to work
drive to physical therapy
exercise and ice
drive to work
drive home
walk to radiation
walk home
eat supper

And here we are.  In less than two days I have already had 4 doses of radiation, and although it's unclear if I am feeling direct side-effects (maybe some nausea already?) I am certainly feeling an indirect side-effect:  weariness.  The first cause of weariness is of course the multiple trips to the clinic, but the second cause is the speed-dial nature of the treatment as compared to chemotherapy.  Chemo was a lazy experience because Dr. Oncologist was often behind schedule, yielding much sitting around, and the treatments themselves were incredibly lazy with their drip drip dripping for hours.  Radiation is heavily caffeinated by comparison:  I arrive at the waiting room and barely open my book before I'm called back to change into a gown, and as soon as I'm changed I go get zapped, then I re-dress, and leave.  The whole thing takes less than 10 minutes.  It is leaving me breathless.  The side effects of chemo defined two types of fatigue, bone-crushing fatigue and lurking fatigue, and radiation is teaching me weary fatigue.

Right, I haven't yet told you about the radiation process.  I'll start with the dressing room.  It puts me at ease because the gowns smell clean like my mother-in-law's laundry instead of clean like the usual scratchy medical gowns.  I gown up and walk back to the radiation room.  It is a large room with a big radiation machine in the middle.  Curiously, along one wall are three display tables filled with snow globes, gifts from patients who wanted to add to the collection.  No one has yet been able to explain the foundation of the collection.  I get up onto the sheet-covered radiation table and lay down with my arms above my head in what I suppose are arm stirrups.  The technicians, who are all super fabulous, scoot the gown away from my left chest and tug the sheet and my body this way and that until my tattoos are perfectly aligned with the lasers.  It is difficult to lie still and let them tug the sheet; my instinct from a decade co-sleeping is to lift my tush and relinquish the sheet.   Once I'm lined up someone says "97", which I think means something regarding the position of the table or the radiation-emitting arm of the machine.  Also, someone places a warm washcloth on the left chest, its purpose to draw the radiation to the skin.  Then the techs leave.  The radiation-emitting arm moves to a position less than two feet from my view, at about "1 o'clock".  The part that faces me is a round flat disk the size of a tire.  In the hubcap position I can see lots of little metallic Kit-Kat-like bars that are always arranged to have some sort of opening in the center of them.  I have determined that these Kit-Kat bars re-arrange themselves to make a person's special radiation shape because they always move into the same shape for me, regardless of how they're arranged when I first look at them.  I've noticed that other people have some pretty complex shapes, but mine is simple:  a generous crescent moon, or a banana that a monkey sat on.  I think the radiation comes through this banana, and only for 20 seconds.  Then the radiation arm moves 180 degrees to somewhere past my left armpit and gives me another shorter dose of radiation, maybe lasting 10 seconds.  I don't know if it's still squashed banana radiation, but my guess is that the Kit Kats rearrange themselves for this new angle.  Anyway, that's it.  I wait for someone to tell me that I can move (just in case), then I hop down.  I get dressed and try to transition back into my day.  Fun times.

One of the technicians said that I'm welcome to have visitors come and check it out, so if anyone is interested just let me know.  I'd be happy to host you, any day, for the next 13 business days, at 8:15 or 3:15.              

Tuesday, April 12, 2011

Tats and zaps and hoots

Last Friday was radiation simulation day.  I laid on yet another skinny platform and slid into yet another over-sized tube.  My arms were way above my head and my head was tilted towards my right arm.  The net result was indeed quite uncomfortable for the as-yet-recovering left region; thank goodness I've been doing physical therapy to decrease the discomfort.  Fancy (CT scan) and ordinary (digital) pictures were taken to map my insides and outsides.  Huzzah to the discovery that my heart is tucked away deep inside my chest and is nowhere near the left chest wall, which is the region to be radiated!  Lasers pointed out coordinates on my body, and three of  those coordinates were permanently marked on my body by a pinhead-sized tattoo.  To accomplish the tattoos, the technician placed a drop of dye on each coordinate and then jammed the dye into my skin with a single needle poke.  One is front and center on my chest, visible with most V-neck shirts.  The other two are on the sides of my torso, near where my elbows rest.  They look like blue freckles.  And that was the end of radiation simulation.

Today was radiation dress-rehearsal day.  In the time since my simulation, the medical physicists took my data and plotted the radiation therapy that I am to receive.  This is arguably the most important part of the whole third quarter because they are tailoring the radiation exactly to my body.  The result should be maximized radiation therapy to the chest wall while minimizing damage to organs.  Today I got to go into the actual radiation room while the technicians took X-ray and digital pictures, again while laying on a skinny table, to confirm that the radiation will go exactly where the physicists have directed.  It was quick and painless, except of course for the stretching of the left arm muscles and nerves.  Tomorrow will be even quicker, and the pain decreases every day.  Yep, twice daily radiation starts tomorrow, and I'll have it every business day for 3 weeks.

The technicians took lots of digital photographs of me, mostly while laid out on the skinny table.  This is to ensure that I get into exactly the same position every day, and I suppose also to confirm that I'm the same person every day.  Wouldn't want to radiate the wrong person, that's for sure.  I'm hoping that their affinity for photos will make them amenable to my desire to snap a few myself.  It would be great to have a radiation photo series just as I made a chemotherapy photo series.

A barred owl has made its home in a tree in our backyard.  Ian is credited with this fabulous picture of it.  I'm taking the owl as a good omen, at least for the radiation portion of my cancer-treatment experience.  It's hoot sounds like it's saying, "Who cooks for you?  Who cooks for you all?"  I find it a very appropriate question for me and the radiation that will be cooking my chest wall.

Sunday, April 10, 2011


She confidently pedals her trike in front of me, her robin's breast red hair streaming behind her.  This is the first season that she's had the agility to ride it without assistance.  Her pride is as fresh as the day.  Her biggness is betrayed, however, by a corner of her blankie poking out of the rear trike compartment, dragging on the sidewalk in her wake.  She will always be my baby.


She is enveloped in my arms, sealed in by her blankie.  She walked relative miles of sidewalks this morning, experiencing spring for the first time on her own two legs.  Now she wants to rest with her mom for a few moments before busying herself with the next task.  As we cuddle, her lips undulate against her blankie's fringe.  I close my eyes and lean to kiss her forehead, breathing her scent of sweat, dirt, and syrup.  She will always be my baby.


Winter has lost its grip on our neighborhood, and I wear no head covering as I walk about the neighborhood.  I can feel the sun on my scalp, coaxing growth from my hair as if it were a plot of daffodils.  The breeze tickles my follicles.  I feel better than I've felt in months, and for the first time feel that everything might actually be okay.

I selected this post to be featured on my blog’s page at Blog Nation.

Thursday, April 7, 2011

Some good news...finally

The tissue that was biopsied on Monday is normal!!!  Huzzah!  What a relief!  I didn't think I was that nervous, but I must have been because my relief knows no boundaries.  Okay, well, the spine thing still has a hold on the negative side of my imagination, so I suppose that that forms at least one boundary to my relief.  But I am nonetheless QUITE relieved!

I'm getting closer and closer to being normal.  I quit taking the narcotic pain reliever today and did well.  Now I'm back to the place where my left "breast" hurts more than my right, which is how it should be in my world.  The right breast barely aches, and it looks surprisingly normal despite the absence of a walnut-sized piece.  It doesn't have a crater or anything.  Also, the nerve pain on the left side has started to subside, which is awesome.  I quit wearing my special sleeve, and goosebumps no longer make me gasp.  Another step in the normal direction is that I worked a full day of work and was moderately productive.  With every day that I put between me and the serious drugs I expect to gain more and more productivity.  I might even be able to drive myself to work tomorrow.

One new stage of my healing include itchiness.  It's kinda weird, too, because I'll have an itch sensation near the rainbow incision, but when I go to scratch it I have trouble finding it because I don't have feeling in the skin around the incision.  Same goes for the armpit area.  Rather than scratching the itch with my hand I have started scratching the itch by wiggling my shirt around.  This broadly-administered friction brings swift relief compared to the game of Marco Polo played by my fingers and the itch.

Tomorrow I have another physical therapy appointment.  I am really enjoying the physical therapy because it makes me stay on task with the exercises, and the exercises are really improving my range of motion.  Also, my therapist does some soft-tissue massage to help the scar tissue loosen up (i.e. stretch in more planes).  It's one of those things that makes me sore right afterwards but feels so much better the next day.

Also tomorrow is my radiation simulation appointment.  This is where my dimensions will be taken for the administration of the radiation.  I understand that I will be getting a couple of tattoos so that I am always put in the exact same position for every radiation dose.  I never wanted a tattoo, and I suppose I still don't want a tattoo.  I must admit, however, that having any tattoo makes me feel a little bit cooler.  Can you just see me at parties?  "That's a great tattoo, Lauren!  Where'd you get it?  Sweet.  I have a tattoo, also.  See?  I got it back in '11 so that my radiation treatments would be positioned properly.  Yea, I totally had breast cancer.  It sucked, but at least I got these sweet tattoos!"  Talk about conversation killer!

Monday, April 4, 2011

Location location location

I mentioned to my good and gentle anesthesiologist that it was four weeks ago to the day that I had a left mastectomy.  I never knew a German accent to be smooth, but his was, and with it he said that the timing was a good omen.  I believe him.

Now that the needle-localized biopsy is over I can finally say that I understand it.  The answer to the riddle is that the upper paddle has a 3x3 inch square hole in it.  I'll back up and explain.

Ian and I arrived at the operating check-in at 7am.  I was whisked away for the gowning and the IVing.  The nurses and I decided not to use my port because it is on the right side, the side of the biopsy, and none of us quite understood the mechanics of how the needle/wire placement was going to work.  We didn't want the needle in the port to be in the way.  With the IV in my right hand I was wheeled on a bed to mammography.  Upon arrival I got out of the bed and sat in an office-style chair.  I explained to the radiologist, resident, and technician that I am not a wimp, but my previous mammogram sent me and my port to the top of the pain scale.  They told me to speak up about my pain and not let that happen again because the previous pictures were informative and such compression was unnecessary today.  This was excellent news, particularly because I learned that my breast would be in compression throughout the needle-localization procedure.

What is "compression"?  For any mammogram one's breast is placed on a height-adjusted, smooth, flat table while the patient sits or stands.  A second smooth, flat surface of variable dimensions is positioned parallel to the table and is brought down on the the breast to achieve extraordinary compression.  The result is a breast that is sandwiched between the two planes, much like a sandwich on a George Foreman grill, minus the ridges.  The upper, compressing surface is called a paddle.  The key to the needle-localization procedure/riddle is that for this procedure, the upper paddle has a 3x3 inch square opening in it, granting the radiologists access to a portion of the compressed breast.  This was my "ah-ha" moment for the day, possibly for the week, because I did not know that paddles could have holes.  I had imagined that the radiologists would be placing the needle/wire from the side or from above my breast (i.e. near my port).  Neither of these imaginings were favorable to me.  A window in the paddle, however, makes excellent sense.  I plan to teach all of my medical caregivers about paddles with windows so that future patients do not suffer such ignorance as I have.

So...I'm seated, my breast is compressed, and they take a picture.  They decide to go in and mark quadrant G9 based on how my breast is situated in their grid.  While compressed and through the 3x3 window, I get a right breast poke with some numbing juice, then a big right breast poke that's headed for quadrant G9.  They decompress the breast and reposition the table and paddle to check on the needle position at a different angle.  They re-compress and snap a picture, discovering that the needle is in the perfect position.  Huzzah!  Now they inject some methyl blue dye to mark the spot.  They also insert a very thin, pliable but firm wire through the needle to ultra-mark the spot.  Then they remove the needle, reposition one more time for one more picture, and at last relieve the compression for good.  They dye and wire remain in the breast.  I'd say that the whole thing took less than 20 minutes.  Know that it was much less uncomfortable or painful than the spine biopsy, although from my post-spine-biopsy notes it would seem that I was in no pain at all.

That was only the first half of the procedure, but the second half is largely unknown to me because I had general anesthesia.  After the wire was localized I was wheeled on my bed back to the operating area, and from there to the operating room (OR).  Then, night night.  The surgeon told Ian that everything went well.  She removed a piece the size of a small walnut and will have the pathology results in a few days.  Oh, and I did have a breathing tube; I now have a sore throat and swallowing is just on the good side of unbearable.

One of the biggest differences between today's recovery and the post-mastectomy recovery is the location of the post-operative care.  Oh my goodness, it was so much better this time!  I stayed in the operating department (named Ambulatory Care Services, ASC), and the nurses were kind, thoughtful, and attentive.  I don't even know the name of the department in which I stayed for overnight recovery last time, but I would not ascribe any of those words to it.  By the way, I think I forgot to mention that I'm home already.

Interestingly, although I am only four weeks out from my left mastectomy, I need to learn to treat my right arm as "injured":  no lifting 10+ pounds for two weeks.  Also, I am to do my physical therapy exercises with both the left and right arms.  At least I don't have drainage tubes, and I got great drugs this time (hydromorphone).  No more Tylenol 3 for this reformed pain scale user!  While on this drug I'm not supposed to drive or do anything that requires me to think. Should be interesting.

Thus far I have discussed three important locations of the day:  my location in time, a location in my right breast, and the location of recovery.  The last location I would like to present is the location of today's post-operative meal:  the Hamburg Inn No. 2 in Iowa City.  It is a diner, and diners are usually a vegetarian's nightmare.  However, this diner offers meat-free sausage and meat-free bacon.  At 2 pm today I was in a private corner booth eating the best greasy-spoon breakfast I've ever had.  Let's also admit that I've had two pieces of pie in the last 24 hours.  What can I say, it's Amish country over there; their pies are ridiculous.

Poke tally:
port  28
right arm 11
tummy  6
left arm  6
right breast 1+
left breast  1+
superior vena cava 1
T9 vertebral body 1

Some crocuses for Becky:

Friday, April 1, 2011

The importance of hyphens

Was March a crazy month or what?  I just looked at my post titles for the past month, reminding me that the platelet transfusion, spine biopsy, and mastectomy were all in the first week.  After that it was mastectomy recovery, herceptin therapy, drainage tube removal, physical therapy, and radiology consult.  Geez.  When did this become my life?

Speaking of my life, yesterday turned out to be far more stressful than anticipated.  Our journey to Iowa City began with car trouble, but we made it just fine (shout out to my grandparents for swapping vehicles with us at a moment's notice).  We had a nice lunch with my undergrad research advisor and his wife before heading to the appointment.  And it is at the appointment where the nerves were hit, both literally and figuratively.  Literally:  Dr. Surgeon totally just whipped her hands all around my incision business.  It was fairly uncomfortable and surprisingly uncompassionate, diminishing the positive impact of her verdict that I am healing nicely.  Figuratively:  Dr. Surgeon clarified that Monday's procedure is not a needle biopsy but a needle LOCALIZED biopsy.  Yes, I had heard members of her team insert that pesky word "localized" previously, but I didn't understand that it is a grossly different procedure than a needle biopsy.  Why would I?  I have previously experienced a needle biopsy where a LOCAL anesthetic was used to ease the pain of a NEEDLE going in and extracting a relatively tiny piece of tissue.  I therefore just thought that this sort of thing is what was meant by "needle localized biopsy".  NO.  I was not hearing the hyphen.  Monday's procedure will be a needle HYPHEN localized biopsy.  Why am I so bummed?  Because a needle-localized biopsy means I will go through the following steps in the following order:  1) mammogram 2) local anesthetic 3) insert wire into the breast while the breast is in the mammogram 4) leave the wire in the breast 5) roll Heather on a cart to the operating room 6) general anesthesia 7) removal of walnut-sized piece of breast tissue 8) breast walnut gets carried back to mammography and visualized 9) stitch Heather up 10) wake her up.

I hereby decree that this should be renamed "directed biopsy".  Leave out the two words that imply other things, or improve the audibility of the hyphen!  And tell patients what the heck it means regardless!!

Does this not sound horrible?  I have many problems with this plan.  1) mammograms of the right breast now hurt like a son of a gun because it pulls like the dickens on my port, which I remind you is stitched to my muscle.  2) A wire being inserted while the breast is squished in the mammogram sounds pretty much like the most awful thing ever.  My bet is that thanks to the port issue it will be more painful than having a hole drilled into my spine.  I'll let you know.  3)  The piece being removed is the size of a walnut.  My right breast is merely the size of two walnuts.  So the reason we're bothering with a biopsy and not doing a mastectomy is because... .  The nurse finished this sentence for me by pointing out that if the biopsy comes back negative, a future mastectomy will be a simple mastectomy.  However, if the biopsy is positive for some sort of cancer, a future mastectomy will include some sort of lymph node dissection.  This is a fine, logical point, and worth it to avoid the lymph node dissection that has life-long side effects.

I am delighted that I finally have some thorough doctors, I really am.  I feel bad for complaining, I really do.  But so far no amount of logic is helping me think that Monday's procedure is going to suck any less.  Arg.

Despite my concerns about the procedure itself, I am not worried about the results of this biopsy.  Again, there was no increased metabolic activity by PET or MRI.  I'm off to have a lovely weekend with the ladies, watching our crocuses bloom!