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July 2012

Try, Try Again

About ten minutes after I published my last post, I got a call from the surgeon indicating that the re-excision was unsuccessful and I would have to undergo yet another sugery: this time, mastectomy.

Another dip in the rollercoaster. Only the dip didn't seem so low this time, the news not quite as devastating, because I knew going into it that there was a good chance it wouldn't work. And I hadn't gotten my hopes up.

I've lived with the news for a week now, and I have to say, I'm feeling ok about it. My anxiety in the past had a lot to do with all of the choices that were given to me, none of which were a sure bet and a decision that was mine alone to make. Because there is no definitive cure for this, and the doctors can't say how any individual will respond to treatment or procedures (and probably for fear of law suits), they won't tell you, "you should do this." They just provide general information about recovery times and survival rates and leave the decision  about which procedure to pursue (lumpectomy vs. mastectomy, unilateral vs. bilateral) up to you. It's incredibly stressful.

But now I know I've tried all my options and really only have one  left, so I'm booked for surgery on August 20th. That means I have three weeks to relax and enjoy Summer before going back in for a single-stage mastectomy (left-side only) with simultaneous reconstruction. It should be pretty straightforward, but with a longer hospital stay (overnight, I think) and recovery (4-6 weeks). And two of those damned surgical drains (blech).

And with it, the addition of two new doctors to my team: the plastic surgeon and radiology oncologist. The former has an intense personality and lengthy resume of accomplishments. He's sort of intimidating, but I can tell he's a perfectionist and will do beautiful work. The latter is much more soft-spoken, but equally accomplished (what else would we expect from the recently-named #1 hospital in the nation?!) and oversees a new kind of radiation treatment which I'm now eligible for. Traditional radiation uses photons, which go straight through your body and out the other side, which make it difficult to work on the left breast since you need to avoid radiating the heart and lung behind it. But this new machine - there are only about 7 of them in the country and MGH has one - uses protons instead of photons and can be controlled with much greater precision. Because of the high demand for it, it is mostly reserved for pediatric patients, but they are also using it for breast cancer patients who have mastectomy.

Six weeks of daily (Monday-Friday) radiation will begin once I've healed from the mastectomy &  reconstruction. They are anxious to get to this stage, as it's been a couple of months now since I completed chemo and I can't postpone it much longer. The challenge has been that you need to get all surgery done prior to radiation because it makes the skin less pliable and therefore you can't do reconstruction after having it. But my body has responded well to the last couple of surgeries so I'm hopeful I'll come through this one smoothly, too, and be ready to get onto the next part of treatment soon enough.

For now, I am enjoying the return of my hair (just barely!) and brows/lashes (which literally sprouted overnight and are still growing):

Before Chemo

During Chemo

After Chemo

And I made it out to Cirque du Soleil for my company's Summer outing, and a Girls' Night Out with Kristen Wiig  and my friend Maria :)



The Re-excision

My surgery went smoothly on Wednesday, although I'm hesitant to even comment on it until I get the full pathology report next week. But here's how it went:

I arrived promptly at 5:20am (along with 33 other people checking in or accompanying loved ones for surgery at that hour!) and was taken to a room where I changed out of my street clothes and waited for an hour before heading down to surgery. No bed in the room (bummer, because I would've enjoyed going back to sleep at that hour), just a wheelchair and a straight-backed chair from which I watched the local morning news (endless coverage of the Southie woman who attempted to ride up an escalator in her wheelchair).

They finally took me down to pre-op, and I was remarkably calm (for me!) while meeting all the surgical staff and hearing about their plans. I don't even remember doing this - or seeing the very cold, brightly lit operating room - last time, because I had so many sedatives in me (remember, last time I had to have that needle localization procedure first).

But soon I had an IV in my hand, and next thing I knew I was waking up in recovery, having some Lorna Doones and ginger ale. The surgery was - dare I say - easy, with the biggest complication being a nearly unrelated one: they covered my eyes in surgery (who new?) and I had a bad reaction to the tape they put on my face, leaving me with two black eyes (it's since turned to more of a red rash).

The surgical site is a bit sore, and I'm tired, but overall doing pretty well. I even got out for a quick visit to Cider Hill Farm yesterday.

I should hear the results of this latest procedure by the end of next week.


Next Steps

I had my week of fun, now back to business.

Last week I met with four different doctors to hear my options for moving forward: my surgeon, oncologist, radiology oncologist, and plastic surgeon. I was absolutely inundated with information, not only from them but from my own research, too (the "Bible" for breast care, and a handful of women who were kind enough to share their own experiences - thank you!).

I'll spare you the gory details (the science around mastectomies & reconstruction is quite fascinating if it's not in fact happening to you) and cut to the chase: I've elected to try a re-excision in an attempt to get clear margins. Basically, the doctors were really pleased with how my body responded to the lumpectomy (healed beautifully...you wouldn't even know I had surgery!) and presented this less invasive option to me last week.

So I go in again on Wednesday, when my surgeon will open up the existing site and remove another layer of cells in hope of getting a clear margin (2mm or more of cancer-free cells around the border of the specimen removed). There is a 50:50 chance that this will work; if it doesn't then I will proceed with a single-stage mastectomy next month. But the re-excision should be relatively easy - a one week recovery and no surgical drains! In either case, I still need to proceed with 6 weeks of radiation and 5 years of Tomoxifen once surgery is complete.

I'm hopeful that the re-excision will work, as I'm ready to get on with life!! I'm feeling well these days - my appetite is back in full force (although I'm definitely more mindful of what I eat, and I am the lightest I've been since College) and my hair/eyebrows/lashes are slowly coming back. I still tire easily, and my fingernails and toenails are a mess (apparently the worst of it hits them one month after chemo ends) but nothing a little polish can't hide.  

I got outside for a bit today and walked the new pedestrian bridge connecting Charlestown's Paul Revere Park  to Cambridge's North Point Park. Here are a few pics:

Heading into Paul Revere Park

Crossing under the Zakim Bridge into Cambridge

Arriving at North Point Park

Enjoying the scenery

A happy local

Time Off

Hi, Everyone -

Just wanted to give you a quick update on things. Everything seems to be healing well: I finally got that nasty surgical drain out (after two weeks!) and am doing exercises to hopefully regain full range of motion in my left arm. I'm still in a bit of pain, and my fingernails are suffering the post-Taxol effect, but I don't have any other side effects and I have a tiny bit of hair growing back on my head!

But as I said in my last post, I was anxious to take some "time off" from Cancer, and spent the last week "living" again. I returned to work, visited with friends, published a blog post on Charlestown Patch, and took full advantage of all the festivities taking place in Boston this week - Navy Week (celebrating the Bicentennial of the War of 1812) and the annual 4th of July Harborfest.

Here are a few of my favorite photos from the week (see the full set on Flickr here):

Ahoy, Mate!
Old Ironsides
The Blue Angels

This week, I plan to talk to a few more survivors about their experiences (specifically with mastectomy) and gather my list of questions for next Monday's meeting with my surgeon and oncologist. I should know more about next steps then.

Happy 4th!