Archive for March, 2008

21
Mar
08

March 21, 2008

Had my second follow-up with the plastic surgeon yesterday – after talking to him about my concerns regarding the right breast, we’ve agreed to wait five months before making any decisions about whether there is a need to try any corrective measures to even it up and potentially reposition it.  I wasn’t particularly surprised to hear him say that in spite of my dislike of the positioning, he considers it to be a job well done, and that there isn’t really a lot that *can* be done to change it.

Part of the problem is that there’s still plenty of swelling in the tissues (on both sides, but particularly on the right), and that because I’m right-handed, there’s additional fluid accumulation on the right side, which appears to all be accumulating under my arm.  Also, another part of the problem is that I have fat tissue under the arm – he showed me how to feel where the edge of the implant is, and sure enough, it is much farther to the left than I would have guessed.  As well, the flatness is being caused by the tightness of the overlying muscle – it has loosened up on both sides, but less so on the right side.

Thus we wait until the swelling and fluid accumulation have dissipated, and allow the muscles more time to relax and adapt to their new state.  The five months is to allow complete healing before we proceed with creating nipples (typically thigh tissue, I think); at that time, if I’m still unsatisfied, we can look at trying some liposuction of the fat tissue.  He doesn’t feel that there is anything he can to with the muscle – one’s muscles have a built-in tightness that can be affected by exercising and stretching, but surgically there’s really nothing to be done to make it looser – it could only be drawn tighter, which obviously would not be something I want done.  I haven’t decided yet if I want to have nipples made – that would be a purely cosmetic thing, for me and Brian to decide if it is worth the trouble.  At this point, I’m tending against it, but we’ll see.  I’m still considering whether a nice dragon tattoo might not be more appealing. . .

I drove for the first time yesterday, and last night started having some sharp, tingly pains in my right breast.  Even though I have been released to drive and start extending my range of motion, shifting is a little more than I really should be doing yet.  Unfortunately, I have to drive myself to another appointment this afternoon, so we’ll see how that goes.  It may be that short trips will build up the range of motion, or may make the pain worse – just typing here is starting to bring on a little sharp jab now and then.  I’m on light duty for the next 5 weeks – not allowed to lift anything more than 10 lbs, no pushing or pulling heavy doors or grocery carts, no reaching and lifting of anything more than very light stuff.  At 2 months, I can do anything I want, but in the meantime, I’m only allowed to do weight-bearing exercises that involve my legs and abdomen.  Once I return to work on the 31st, I will have to be careful to stick to the restrictions – hopefully by then driving won’t be causing any difficulties, or I’ll have to figure out how to get downtown without driving (from my house, taking all public transit means a 1-1/2 to 2 hour commute, each way).

The new medication, Femara, doesn’t seem to be causing any increase in my menopausal symptoms – I have started having some pain in my left knee, and a little bit in my right hip, but I wouldn’t expect it to happen that quickly – it started on Monday, after only my second dose.  So I suspect that the knee pain is a recurrence of an occasional problem I’ve had prior to this, and am attributing the hip pain to not getting enough exercise.

Last week my weight was down – this week, based on my home scale, I’m expecting that it will hold steady, or perhaps go down a little bit.  I’ve been sticking to plan, but haven’t done as good a job as usual at getting the right balance of foods in.

Have a happy Easter!

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18
Mar
08

March 18, 2008

Well, as I thought might be the case, I’m feeling much more my normal self today – in some ways, I look at yesterday’s post, and feel as if I could climb right back under all the depressing feelings and be right back where I was then; but I can also look at each individual feeling more clinically, and say “Empirically, yes it is true that I feel (or have felt) that way, but it’s not how I *normally* feel.”

As someone who has historically been most excellent at stuffing my feelings, and causing lots of problems for myself by doing so, it is tempting to justify my outburst as needing to vent.  And again, that is empirically true – it is a good thing to let the bad feelings out.  Blurting it all out in a public blog is something that was both wildly successful (in the sense that I *do* feel much better today) and appalling to me (I’m normally a pretty self-contained person, and when I do talk to friends or family about my feelings, it is usually after I’ve mulled over them and clarified them to myself (not brooded on them) before I share them).  Brian occasionally gets the brunt of undigested emotions, but for the most part it’s so that he can help me do the mulling and clarifying.

At any rate, the fear and sadness, the frustration and worry, those are all things I feel, but typically they don’t all hit me at one time.  Normally, I may be aware of one or two of those feelings at any given time, but they’re outweighed by my prevailing attitude, which is the more optimistic and positive way I feel most of the time.  Yesterday was one of the times when the feeling that my life has completely changed in a way out of my control (and for a control freak, what could be worse!) was overwhelming.  In reality, my life has and will only change as much as I let it – whether I have my ovaries intact and whether or not I have “real” breasts is a physical change, and I can let it change who I am or not, as I choose.  Most of the time, my choice is to direct the changes towards the positive, letting myself explore my artistic and creative side; being there for friends who have worse problems (stage 4 cancer is pretty damn serious); and enjoying life and people for who and what they are at any given moment.

Obviously, there are days when I don’t have the strength to stand up to that ideal – yesterday was one of them.  Fortunately, they are few.

17
Mar
08

March 17, 2008

Today I’m tired, and depressed.  It’s going to take more than a green beer to cheer me up.

Even though I know that I should expect some emotional fallout from just having had surgery, and potential mood swings from entering menopause, I am just tired of dealing with cancer, of dealing with the “necessary” mutilations done to my body, and of dealing with having to go through recovery from surgery once again.  I’m angry at having to be afraid of getting another pulmonary embolism, one that might be less survivable than the last ones.  I’m frustrated at having to take all this time off work, with *none* of it being vacation, and all of it stuck at home.  I’m hurt at friends who don’t call, or e-mail, or visit; and annoyed at people who feel as if I should be calling them long distance because I’ve got all kinds of time on my hands and they are important enough to warrant a personal report on how I’m doing, without considering that I haven’t had more than half a paycheck coming in since September.  I’m sad because my hair will grow back, but my breasts won’t; and devastated at what I consider to be the awful results of the reconstruction.  I feel guilty for not having the dna testing that would tell us if my family carries the breast cancer gene markers; and worried because the extensive family history seems pretty clearly indicative that it does.  I’m grumpy about not being able to sleep at night.  I’m afraid that I won’t be insurable in the future, and I’m not even fifty yet.

However, I am grateful for the friends and family who do call, e-mail, and visit, and most importantly, care; for the fact that I was very fortunate to catch the cancer early; for the fact that I survived a pulmonary embolism in each lung, in spite of being misdiagnosed at first; for being able to take as much time off as I have and still being able to meet our mortgage payment and other important bills; and for not yet being fifty.

I’ll get over the depression, and one of these days I won’t be tired out, I’ll get back to being able to sleep at night, and will even have times when I do not think about what I’ve had to do to my body to survive, because I won’t have constant reminders of pain and discomfort that force my attention to my scars and my misshapen form.

15
Mar
08

March 15, 2008

Saw the ovary surgeon yesterday, and she says everything looks good, and I can start getting the scars wet now – there’s still quite a bit of crust on them, mostly held in place by the surgical glue they use to hold the outside of the scar together, and although it might bleed a little bit as it comes off, it’s now fair game. I have to be sure to watch how much bleeding they do, though, since I’m still on the blood thinner. She also says that I can start some very light exercises that use my abdominal muscles, but very few repeats to start with, and work my way up very slowly, stopping if there is any pain. The bruising and damage to the tissues tends to be exacerbated by the blood thinner, so it will take me longer to heal than it otherwise might have. I still have external bruises from the blood thinner injections that I was getting before the surgery, and it’s been around three weeks for those, with at least another week to go before they’re gone – she indicated that the internal “damage” from the operation will take at least as long to heal.

My digestion finally seems to be nearly back to normal – still a couple blips here and there, but for the most part, I seem to have gotten past the surgery/drug-induced difficulties. I haven’t had to take any pain pills for the last couple days – I do still get isolated pains, and when I swallowed some juice wrong, had a coughing spell that was very uncomfortable during, but the pain faded pretty quickly after.

I see the plastic surgeon again later next week, but I confirmed yesterday that I can now get the scars wet – I can’t shower on the front side, because the water drumming against the tissue can cause swelling, but I can let the water run over my shoulders from behind. I can also start doing a little bit more with my arms (not too much, because swelling is definitely a concern; plus still no pushing, pulling, lifting anything over 10 lbs, or too much repetitive motion), and they even said I can drive if I feel comfortable, even though I have a manual transmission. More than anything, I suspect that what will drive my driving is how tired I get. Brian drove my to my support group meeting on Thursday morning – I hadn’t been for a couple months because it interferes with work hours, so I hadn’t seen anyone there for a while. After the meeting, we had a little lunch at the hospital cafeteria, and my friend Sue drove me home, with a short stop at the grocery store to pick up some half-and-half. After she dropped me at home, I basically just collapsed in my chair and after watching an episode of Stargate SG1, slept for two-and-a-half hours. And Friday, I rode downtown with Brian because I wanted to go to my Weight Watchers meeting – hadn’t weighed in for the previous 2 weeks, and I didn’t want to miss another one. However, Brian had an early meeting to go to, so I ended up waiting in the Borders bookstore cafe for a couple hours (bought some books and had some tea, so I was mostly sitting down the whole time). From there I walked over to Pioneer Place and the meeting (down 5.8 lbs for 3 weeks – whoo-hoo!), and then met Brian back at the car. Then we drove to the follow-up appointment, and it was while I was sitting in the warm, not-so-comfy exam room that I realized how tired I was – from walking a total of about 2-1/2 or 3 blocks and otherwise mostly sitting down all morning. When we got home, I slept for three hours, even with Robin going nuts when Brian came back from a client site, and the phone and doorbell ringing. So I still don’t have a lot of energy to spare, and the doctor said no matter how healthy you look on the outside, it just takes a certain amount of time for the body to recuperate. Another two weeks should have me ready to start back at work at the very least half-time, probably more – she said it would be a mistake to push too hard and have a set-back.

At any rate, I’m taking it very easy – watching a movie or two, some Stargate episodes, lots of reading and napping. Poor Robin is happy to have me at home, but disappointed that it involves so much sitting around. He thinks I should be able to chase him around the back yard, or at least play rope with him. Augie the Dorkie and his mom came for a visit on Tuesday, and the two boys entertained themselves while Cathy and I visited. I still can’t knit or bead or anything, but hopefully soon.

Oh yeah – the ovary surgeon said that it would only be about 24 hours after the surgery until the estrogen built up in my body dissipated, so that I would start experiencing whatever symptoms of menopause I’m going to have very quickly (i.e., as of now, I’m probably at the worst it’s going to get). Basically, I do have my hot ‘flashes’, and sometimes more of them than other times – I haven’t yet had a chance to identify triggers – but they’ve been very controllable by removing my hat or scarf, and at night pushing back the covers if necessary. I also dug up a little hand fan, which helps when I’m in a situation where I can’t remove any more clothing. Definitely layering is in my future ;-} She thinks I might experience a little bit more once I start taking the aromatase inhibitor (Sunday). Hopefully it won’t be too bad.

Even after sleeping in this morning, I think I’m ready for a nap. Cheers!

Julie

08
Mar
08

March 8, 2008

Ouch.

Do you know what happens when you are startled, say, when someone sneaks up behind you and touches you, or when you’re playing a computer role-playing game, and the bad guy jumps out in front of you unexpectedly?

You jump.

But do you know the specifics? Your pelvic floor tightens and jerks upward, your abdominal muscles tighten and pull inwards, and not only that, but quite probably, if you’re sitting down, you involuntarily push yourself upwards in a flight response, however aborted.

Ouch.

I had thought that, in spite of the ongoing pain as the usual bowel function has been restoring itself, I was starting to really improve, and that the abused muscles and tissues were starting to reach normal levels of usage without too much pain.

What the above reaction showed me is that in fact, I’m still babying my body, and with very good reason. I started paying attention, and I noticed that I still move very slowly, and initially I walk hunched over my abdomen slightly and straighten up only after several steps. I’m still resting against the backs of chairs when I sit down, although normally, I typically sit forward. Trying to stay upright on the exam table requires a lot more effort from one’s abdominal muscles that I realized. Bending over, I’m using lots of support from my arms, which is OK as long as I don’t push down, or put a lot of weight on the arms (or move them very far in any direction). When you just have laparoscopic surgery, you depend on your arm and chest muscles to compensate for not being able to use your abdominals. When you have breast surgery, you depend on your abdominal muscles to compensate for not being able to use your arms or your chest muscles. When you’ve had both. . .

So no scary movies for me for another week at least.

Weight-wise, I’ve actually dropped four pounds in two weeks, mostly because I haven’t been eating a lot. I’m generally back to normal foods, but my appetite is feeling pretty reduced.

We met with the plastic surgeon on Thursday – he’s pleased with the general results, although I think he agrees that the right side is currently not looking the way *I* want it to look (it may look fine to him, as far as being a surgeon goes, but aesthetically, I’m not happy because it still bulges too much to the side and is still fairly flat on top). Of course, there’s swelling, and so it’s hard to tell what it’s going to look like in the long run – before I freak out and start demanding that it be put “right”, I’m going to control myself and wait to see what it looks like once it is declared healed. The left side looks pretty good – still bulges a little to the side, but it’s more rounded and evenly proportioned. I have to do nothing with my arms for another week, and have another appointment in two weeks.

My ovary surgeon is in Maui for ten days (I hadn’t realized that I’d forced her to do a major operation the day before she was leaving for vacation, but it explains the hesitation her scheduler had about the 29th, and also why in the face of the hesitation she didn’t suggest moving to the next week). I’ve had some difficulty getting the pain medication and the stool softener dosages correlated properly – Brian and I call it the Porridge Paradigm, and decided that the point is searching for the Goldilocks Effect. You know the story – this porridge is too hot, this porridge is too cold, this porridge is just right; this bed is too hard, this bed is too soft, this bed is just right – substitute stool for bed, and you’ve got the point. However, I’ve managed to reduce the pain pills to roughly 1/4 – 1/3 the maximum dosage I was taking (although I bumped that up briefly after the little “dungeon exploring accident”). My follow-up with her is in a week.

I also met with the oncologist for the first time since my last chemo in December. Now that I’m post-menopausal, he wants me to start my aromatase inhibitor, and we’ve settled on the particular one (Letrozole, brand name: Femara – don’t you love these drug brand names? This ones sounds so feminine yet mature. . .). He gave me a month’s sample to get me started. I’m planning on starting it on the 16th (he doesn’t know that – I decided that after I’d gotten home from a long tiring afternoon). But I don’t think my body is quite ready for a major influence change this close to having had surgery – I’m going to give it another week to heal, and to shake out the new status of being a (mostly) estrogen-free state (not quite like Jefferson Free State, but we no longer owe those annoying hormonal taxes). I haven’t had a lot of reaction yet to the lack of estrogen – as I mentioned in my previous post, I had started sleeping warm again, and that is continuing; however, I am starting to have hot spells during the day (they don’t really “flash” – that makes it sound as if you are just all of a sudden sweating and way too hot – mine creep up on me, and if I ignore them they will kind of “flash”, but if I take care of it as I feel it coming on, by removing my hat or scarf, it’s usually just fine). I asked the oncologist how quickly one should expect the estrogen to be gone after surgically removing the main source, thus triggering official menopause, and he admitted that he doesn’t know. I’ve tried to find it on the ‘net, and haven’t found anything that really specifies that particular information. Should I be searching for “estrogen half-life” or something? I guess if I don’t know what my base level of estrogen was to begin with, knowing the half-life wouldn’t really be any help.

So that’s how it’s going for now – mostly not too bad as long as nothing sneaks up on me.

04
Mar
08

March 4, 2007

Hi y’all –

Thank you, everyone, for the cards, calls, flowers, and visits! I am doing pretty well, for the most part. I had a lot of pain on Saturday while I was still at the hospital, but Sunday and Monday I had cut way down on the pain pills because I wasn’t having a lot of problems.

Sunday evening the waited-for event, some indication that my bowels were coming back online, made itself known, and I celebrated by reducing the pain pills even further. It all started to seem pretty normal, but then Monday evening, I hit a snag. Rather than constipation relieved by the stool softeners, I started having diarrhea, which I suspected was being exacerbated by the stool softeners because I’d reduced the amount of oxycodone, but not the colace. Suddenly, there wasn’t as much need to soften things, but it was still working on it. I also developed a mild fever of 100.4 degrees, which is verboten after surgery. Since it was midnight by the time I took my temperature, I didn’t call the doctor, and planned to call them this morning at 8:00, after having taken my temperature again so I could give them an accurate update. I also bumped the oxycodone dose back up, both because I was starting to feel a lot more pain, but also because I thought it had acetaminophen in it to help control the fever. Apparently I was wrong about that, but it certainly helped with the pain.

By this morning, my temp was back down to normal (which for me is typically right around 98 degrees).  The surgeon’s advice nurse said to call if my temp went back up, but otherwise I could just take some immodium for the diarrhea.

So far I haven’t had any indications that I’ve entered menopause, and have even been chilled, rather than too warm. Finally, last night while I was snatching cat-naps between cramps, I started sleeping hot again for the first time since my surgery (something I’ve done for many, many years). I had to strip the blankets off, take off my hat, remove my sweater, and pull my neck scarf off – all items I’d been too cold to go without since I got home from the hospital. Even though I started out by putting everything back on, I just kept having to remove it all again, so I ended up wrapping the scarf around my shoulders and pulling up one blanket.

I haven’t been focusing on eating all my points for Weight Watchers, mostly because it has been a bit of a struggle to eat much of anything.  I do get hungry, but it doesn’t take much to satisfy the hunger, and so I haven’t been worried that I’m overeating.  I probably am undereating, which is just as bad, but I had planned on taking one to two weeks break, and am hoping that at the least I will maintain my previous weight loss, and if I’m lucky lose some more, rather than putting on anything.  As of this morning, I’m at about the same weight I was at my last official weigh in.

The laparoscopic scars are small, and although I’m sure there are stitches inside, the outside was only sealed with glue.  As I’ve had to clean spots to give myself my Lovanox injections, I clean off the iodine – there are gleaming white patches amidst the jaundice-yellow overall tone of my skin currently.  I haven’t seen the scars for the reconstruction yet – my first post-surgery follow-up appointment is Thursday, and I can’t change the dressing or shower until then.  Fortunately my hair is so short that I don’t have to worry about trying to keep it clean – also, I still haven’t gone back to my excessively oily skin and hair that I had prior to chemo.  I’m hoping that part is a permanent change.

I’m about due for my next dose of pain pills, and am going to have a mug of boullion then lay down again.  I haven’t had a lot of focus so far, yet it’s so much better than the previous surgery – I can read, and although I don’t read much at a time, I *remember* what I’ve read so I can be right back into it when I pick up the book again.

Poor Robin is resigned to my being boring again – he follows me everywhere (I am still getting up and pacing around the house periodically), and collapses at the foot of my chair if I don’t get the foot elevated right away.  Sigh.

Julie

02
Mar
08

March 2, 2008

I’m home – they sent me home Saturday late afternoon, and although I’m definitely having pain, it’s controllable with the pills they gave me. I spend a lot of time snoozing, and I always think I’ve slept a lot longer than I really have – It always seems like 4 or 5 hours, when it’s only been 25 minutes or as long as an hour-and-a-half.

So far, no symptoms of menopause – in fact I’m having the reverse. I’m very cold. Frankly, I’d prefer that, because it’s a lot easier to layer on than to layer off.

Anyway, just wanted to touch bases, and let you know that I’m doing well. I will write more later.

jkm




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