A Lucky Hand?

Today, I had an appointment with my Plastics MD....and guess what? She had the results of the mysterious OncoType DX test....4 days before my scheduled appointment with the Oncology MD. (Cue ominous music......)

If you recall, these results are read as a number between 1 and 100. If that number is ↓18, then there’s "little to no chemotherapy benefit, as there’s a low risk of distant reoccurrence," and only hormone therapy will entail. If the number is between 18-30, likewise, there is "no substantial chemotherapy benefit," and again, only hormone therapy will be necessary. A number ↑31 means that chemo does have a "significant statistical benefit."

My result?     21......make that "Lucky 21?"

Granted, I'm "just a nurse," and must wait for the physician's interpretation and recommendations on Monday. I just hope she concurs with mine.

 

The Randolph Model: The 5 Stages of Grief

Kubler-Ross created 5 Stages of Grief to explain how humans react to profound news of death and dying. Her stages included:

1. Denial: Individuals believe there's an error in DX or info, & cling to a false reality.
2. Anger: Anger ensues after the individual recognizes that their denial cannot continue.
3. Bargaining: An internal negotiation for longer life or lessened consequence, is sought.
4. Depression:  Now, the individual is saddened at the recognition of their mortality.
5. Acceptance: Lastly, individuals embrace their mortality or inevitable future with a calm, retrospective view, and a stable condition of emotions.

Randolph's 5 Stages of Grief, is somewhat parallel, but immensely simplified.
1. Denial: Are you fucking kidding me?
2. Anger: Fuck you, you fucking motherfuckering whore!
3. Bargaining: Fuck that shit!
4. Depression:  Fuck me. 
5. Acceptance: Oh, fuck it!

 

 

The Week of Magical Thinking

“Magical thinking” is defined as the belief that an object, action or circumstance not logically related to a course of events, can influence its outcome.

We are all magical thinkers, to some degree, finding solace and comfort in ritual and belief.

Do you wear a wedding ring? That's magical thinking. Do you hope that karma exists, and your enemies will get what they deserve? That’s magical thinking. Do you ever yell at inanimate objects for the harm they've caused you? That’s magical thinking. Do you believe in luck, fate, kismet? That's magical thinking.....

I'm still awaiting the results for definitive medical treatment of this pesky breast cancer thing, on Halloween, to be exact. Until then, I try to be resolved and patient, and (dare I say it?) hope for the best. It wouldn't hurt to get lucky.....cross your fingers for me.

 

 

 

 

 

 

 

 

 

Does Cancer Make You More Profound?

To paraphrase Jane Austin, "It is a truth universally acknowledged," that a woman with breast cancer, must now acclaim deep and poignant wisdom on life and the meaning thereof.  "However little known the feelings or views of such a woman may be on first" being diagnosed, "this truth is so well fixed in the minds" of her surrounding friends, that she is considered a learned sage. (Pride & Prejudice, p. 1)

Now, I understand the connection between having a life-threatening illness and attempting to act as the intermediary between the living and the dead, by trying to solve all of the mysteries of existence....hopefully before your own potential demise. A tall order, indeed, but who knows?  Just because no one else has ever been able to fully complete the task on deadline, there's no saying I can't....right?

Personally, I think I talk some pretty good shit. I'd like to think that most everything I say is riddled with weighty import and should be made into a Hallmark card, or at the very least, a viral meme. In truth, I know that getting hit with the cancer-stick has not made me any more perceptive, but has simply given me a more precise focus and a ready cyber platform, along with a wonderful diversion. And, an overly receptive audience that already loves me. Thanks.

Sleep When You’re Dead

There’s an old adage, that on one’s deathbed,  there are no regrets about not having spent more time at work. The message being that there are more enjoyable pursuits, and that one would never consider “work” as a worthy venture. I beg to differ.   

Although I struggle for legal tender in a variety of means ,  I define myself as an ED Nurse.  And while it’s true that not all my professional time is worthy of a Lifetime movie, there are moments that I’ll always remember as “personal bests, ” and those moments required my physical presence doing the job. I don’t regret the time there. Of course, even the best day in the ED will always get beat by an afternoon on a white sand beach, gazing at the horizon while holding a mai-tai. I’m not completely insane.  

One of my favorite Twilight Zone Episodes places a man in newfound possession of a stopwatch that stops time, giving him unlimited opportunity to do anything. Imagine if time was not a limiting factor in your accomplishments: I could finally learn Spanish (and French and Japanese); learn the guitar (and the ukulele, piano and cello-the Game of Thrones theme is the best); write a breathtaking novel; travel everywhere; study important scientific things (Quantum Physics, comes to mind). As it is…I try to accomplish what I have to, and most everything else gets placed on the back-burner. Boy, if I didn’t have to concern myself with ensuring a supply of clean underwear in this house, I could really be an earth-shaker!  

More realistically, and for the short-term, I’d like to focus on learning  how to:

1. pick a lock.

2. hot-wire a car.

3. Tokyo-drift and spin 180 degrees.

4. flip a butterfly knife.

5. throw knives (pretty much do anything dangerous with knives).

6. wield a light saber.

7. use the power of the Force.

8.  ensure fully-funded education, housing and heath-care for all.

9. create world peace
10, discover the cure for cancer.

 

There are not enough hours in the day to accomplish what I’d like to do.  I’ve always said my motto was “That which does not destroy me, makes me stronger,” but I think I want to change it to “Just get shit done.” You can always sleep when you’re dead.

 

 

It’s a Numbers Game

 

I'm  healing amazing well; my doctors are quite impressed. I'm just a little sore. And after the first of 4 weekly fill'er-up's, my right boob looks just a bit deflated and a tad bruised, but that's all. After the last fill, it will be a mirror image, a matched set, 2 peas in a pod. Astonishing, huh? If that were the end of the story, I'd be doing cartwheels....or some other similar enthusiastic expression of joy within my realistic set of physical abilities.  

But, to go all Shakespearean on you, "alas, my precarious situation, is engendered by a sense of foreboding." In medicine, we refer to it as a "sense of impending doom." You see, my definitive test results (Oncotype DX Breast Reoccurrence Score), along with an appointment with a renowned oncologist, occur on Halloween....10 days away.  These results will ultimately be read as a number between 1 and 100. If that number is ↓18, then there’s "little to no chemotherapy benefit, as there’s a low risk of distant reoccurrence," and only hormone therapy will entail. If the number is between 18-30, likewise, there is "no substantial chemotherapy benefit, "and again, only hormone therapy will be necessary. 

But if the number is ↑31, the studies have shown that chemo does have a "significant statistical benefit."  And then a new nightmare begins.

 

Interestingly, my plastics MD said my ultimate reconstruction wouldn't be until after about 3 months of the last fill...that works out to about Valentine's Day. My surgeon said if it comes down to getting chemo, it would start about 4 weeks after surgery and last about 12 weeks...which works out, again to Valentine's Day. Either way, I'm gonna need a shit-load of chocolate.

 

So, I wait….and everyday I think about the possibilities, and it terrifies me.

 

There is No "Battle"

In recent years, there has been a dramatic personification of one’s reaction to life events: we are expected to “combat” each untoward occurrence, and project our bravery onto the scene. If I had broken my leg, you wouldn’t be rooting for me to “fight” the broken bone, but when I say have I breast cancer, suddenly, I’m expected to “win the battle.”

Valor ensues when a choice is made against one’s own self interest; it could be a life or death situation, worthy of an epic poem, or maybe just standing up to ignorance, prejudice or injustice. That’s being brave.

This whole cancer thing is really more of a hostage situation: there are no real choices, just an escape plan.  

Don’t get me wrong: I greatly appreciate your support, but it’s all just a painful slog through necessary crap to accomplish an end: just like sitting in rush hour traffic on the 405 to finally get home. It's all perspective. In the end, I’ll have remarkable décolletage, along with new awe-inspiring character depth and insight.

So save your pink ribbon crap for someone who needs it. I’m just doing what needs to be done.

Size Matters....

One week after a relatively big-time surgical procedure, I've been waiting for the other shoe to drop. And it has.

My surgeon called with the pathology results this afternoon, and the numbers are in: T3, N0, M0. What this translates to is: T3: the size of the assorted bits of cancer badness scattered throughout my right breast was over a space of 6cm; and even though that wasn't a solid bunch of shit, it still counts....The N0 and M0 mean that there's no spread to lymph nodes, or other organ systems (metastasis)....that's good.

So what's next? There's a more precise analysis (Oncotype DX) of my right boob, lying on a slab somewhere, to be done wherein the exact genetic  findings will guide a more individualized approach to potential therapies.....the test won't be back for 2 weeks however, so until then...more waiting....and the existing boob gets incrementally filled-up for the silicone changeover to come.

I'm hoping for a low score (18 or less) which will mean only hormone therapy (oral meds) for the next five years, along with a more perfect right 38C. A higher score?.........That's nothing I want to consider or speak of, just yet. I hope you understand.

love to all

Day 6: Dead Man Walking....

As I've alluded previously, my cosmetic result from this surgical event, although still in-progress, is really pretty remarkable: imagine a pristine 38C that's about 2/3 deflated and a bit bruised along the edges....but with awesome potential! As Lenin said (although likely not in the context of breast reconstruction): to make an omelet, you gotta break some eggs; here, my fabulous plastic surgeon used an Acellular Dermal Matrix (ADM): a human-derived tissue matrix that provides a scaffold upon which my own cells can repopulate and re-vascularize to fill in the voids and help the temporary tissue-expander adjust to the neighborhood. Clever, huh? 
 
http://emedicine.medscape.com/article/1851090-overview

In other words..."dead boob walking." I will owe my soon-to-be Victoria Secret worthy set to someone who checked the box saying "Donate everything...use it anyway you want."

Thanks dead guys.

Day 4 & 5: Analysis of PMH

In medicine, you're always reading the patient's story from the middle of things (in medias res), and then trying to look into their past, as to how they got into this state of physical badness in the first place. With the lung cancer patient, you shrug your shoulders and say, "well, he was a smoker." For the drinkers, we shrug again, and say "of course, his liver failed." PMH/Past Medical History is our attempt to connect the dots of our patients' life events: to see cause and effect played out in astonishingly vivid tableaux vivants, where, only sometimes, do we possess the means to set things right.

This being said, here's my own PMH analysis:

"Things That Gave Me Breast Cancer"
1. Eating inadequate quantities of rare red meat.
2. Sitting too close to the TV (Oh, wait...that ruined my eyes.)
3. Getting a curly perm in 1977.
4. Getting another curly perm in 1978.
5. Living on Top Ramen, popcorn, rice and copious alcohol, in my starving student days.
6. Buying a Beta-Max, instead of a VHS.
7. Sitting in the middle seat on Southwest Airlines.
8. Refusing to waste my finite number of heartbeats on useless exercise.
9. Holding my flaming butane lighter above my head, at the finale of every rock concert. 
10. Listening to my 8-Track stereo.
11. Wearing a Mood-Ring.
12. Reading all the Fifty Shades of Grey books.
13. Watching the Fifty Shades of Grey movie.
14. Using a curling iron to make my hair look like Farrah Fawcett's.
15. Using a flat iron to make my hair look like Jennifer Aniston's.
16. Listening to the Small World theme for 8 hours/day in the summer of 1978, while captive in a Disneyland ticket booth. 
17. Drinking cheap keg beer, from a red Solo cup. 
18. Watching the entire Lost series.
19.  Wearing my Polo shirt with the collar turned up.
20. Waiting for my dial-up internet connection.

love you all.....

Day 3: The Aftermath...

WARNING: This post contains graphic descriptions of anatomical features, such as "nipple," and may be offensive to those who are whinny little bitches.

So, here's the skinny on this whole breast cancer thing: in the old days, everything was gone in one fell swoop, you went from Marilyn Monroe to an Amazon faster than you could say "general anesthetic." Today, there is a kinder, gentler approach where only the truly misbehaving underlying tissue is taken off the reservation and exiled. That's where I fit in....thankfully.

But this approach is not unproblematic, especially in someone (like me) who has already had their furniture re-arranged (eg: boob reduction). In my case, this new ongoing design process requires the surgeon's skilled and creative touch. You see, in order to preserve the blood supply to aforementioned re-arranged nipple, not only is vascular manipulation required, but also a pharmacological adjunct in the form of topically-applied nitroglycerin cream. Sounds simple so far, right? Except this NTG, just like it's explosive counterpart is MAKING THE TOP OF MY HEAD EXPLODE! It's action is that of necessary vasodilation (making the boob's expanded blood vessels feed the nipple-age), but drugs are systemic, and the vessels in my delicate frontal lobe are maxed out....sigh...Small price to pay for the future semblance of normal breast anatomy...I know, I know.....but, there that.

In counterbalance, the boob doesn't really hurt much...just kinda sore. Really. Sure I can't do marine push-up's or, well, reach for something above my head, but overall, really not too bad. I tried the infamous "Norco" pain pills, the MD's supplied, but it just makes me sleepy. I'm working on the precise CR-pharma-formula (I'm sure it will have a vintage year in the title, with an Ativan chaser). 

Love to all...

Days One and Two

As I was waxing poetically about my next blog posting, I realized that my drug-inspired mist only provided the glimmer of astonishing and profound thought, but not the action required. So please accept my apology in advance for being already behind on this chronological missive.

On 10-10, the surgery itself: all the nursing and medical staff were at once, both kind and professional: everything you would want in someone pending to hack off 2 pounds of your diseased flesh. I was escorted to the OR and after getting tucked-in, with the mandatory "warm blankets," was given an IV cocktail that hours later, made you feel as mere minutes had passed. I should have paid more attention in Chemistry class....amazing stuff.

Rich and my friends Stacee, Rita Kae and Frank stayed the duration (well, mostly, except for when everyone but Stacee left for lunch, and she alone, received the surgeon who came to say "lymph nodes are all clear.") These are important words in the Cancer game: akin to "even though you were in a horrible car accident, your insurance will cover it," or perhaps "even though we cut off most of your right boob, your left is all clear.." Something like that.

Spent the night in the hospital in no significant distress, but totally exhausted. Kind of like when you stayed up the whole night to write a term paper on the projected effects of microeconomics in a macroeconomic environment, in Kenya. It was a wonderful opportunity to savor the effects of IV narcotics, which I've never known. (My drug of choice is Cabernet.)Now, I actually have first-hand (or first boob) experience with that drug that starts with a "D." Whenever my patients ask for it in that manner, I always reply: "Do you mean Docusate?"

I was expecting some fabulous out-of-body experience, but just felt sleepy. I'm not sure where that places me in the drug-seeker spectrum, but I am grateful not to have the future need to ruin my life and looks in pursuit of my next high....maybe just in pursuit of my next nice purse.

Modern pharma provided some interval hours of sleep, and in the AM, after getting the seal of approval from my wondrous plastics MD, I was good to go. Fluffy pillows and the reclining passenger's seat latch made the trip home another memory blur....and now, embedded here at 540 Highway One, with yoga pants, and electronic devices aplenty, the healing shall begin...I appreciate your love and good thoughts from afar, and look forward to seeing everyone with a really spectacular new rack.

Day Zero: The Night Before

It's just 16 hours to my planned mastectomy surgery and I'd like to say that I spent the day in quiet contemplation and reflection. But that would be untrue: It's hard to drop everything and live on the ethereal plane: in other words, I did the laundry, cleaned the house, put up provisions and did necessary paperwork. But at noon, I opened the front door, to find my BFF, Stacee there, at my request...and all was entertaining diversion....Stacee is at once, a Majordomo and a whirlwind: the best recourse for interaction with her, is always to listen more than one speaks. Tomorrow's plan is an early morning journey to the hospital, where I'll stay overnight and come home on TUES.....and then, thru a likely narcotic-enhanced haze, continue this explanation. Of note...the Amazons would cut off their right breast to enhance their archery skills.....let's just say: I'm all over that....