Every Birthday....

..is also an anniversary.  Because my surgery was on June 28 and my birthday is June 27, I can't help but remember the surgery that "started it all" every time I celebrate a birthday.  It's rather convenient, actually.  Every year that I say to myself "Wow, I made it!  Let's do it again!" I'm reminded just what got me to this day, or as they say in a Hebrew prayer "...shehecheyanu, v'kiy'manu, v'higianu, laz'man hazeh"  (or, roughly, for keeping us alive and allowing us to get to today.)

So, yesterday was June 28 - FIVE YEARS from my blog entry titled "Separating the Saucer Sections."  Good grief, how clever was I at 5 a.m. back then? 

Saturday I turned 60.  Years ago, people with breast cancer didn't get to celebrate a 60th birthday.  Today, some do and some don't, but more do, for sure.  I can't speak for everyone in the latter group but speaking for myself, I'm grateful.

Rod gifted me with a hammock which arrived on June 22, prompting several Facebook posts that started with "A View from the Hammock." Here's the first one:

For my actual birthday, I went to services in the morning, then out to dinner with my favorite dessert, zabaglione, made tableside.

Like I said, grateful.

30 Days Post

May 7 - 30 days post-surgery.  Time to check in and update.  

So after that first appointment, Elyssa took me home and I set myself up once more in "recovery mode:" Plenty of fluids, 2 phones, iPad, bottles of meds, all on a tray on the bed so I wouldn't have to reach backwards.  (Rod's idea.)  During the day the tray sits on the bed, and at night it moves to a "tv tray" table placed precisely so I can reach it AND still swing my legs around to get to the bathroom.  Whew.

Not knowing that I was going to have drains (ahem) I had failed to acquire a new fanny pack to hold them in, so on to Amazon and they (2 for just in case I need one for the shower) arrived by Saturday.  So at least now I didn't have to always pin them to my clothes. I try to be the "queen" of long-range planning.

For my next appointment, on the 15th, we actually saw the doctor and he (once again) admired his work.  (Thanks to Elyssa for again driving and taking notes!)  He and Yui (his nurse) said my drain numbers (now tidily lined up on a sweet Levenger note card instead of scrawled on the photocopy sheet from the hospital - I have my standards) were good, but not great.  They told me to take it easy and call on Monday, when they felt certain a drain would come out.  I believe what I heard (and perhaps not, in retrospect, what they said) is "call first thing Monday and you can come on over and we'll take at least one out."  We are also told (and this I'm certain about) that the left drain can only stay in for 2 weeks, max.  Something after foreign body, infection, blah, blah.  (And, true to his nature, Doctor D'Amico slipped in a snarky remark about that being the side where the radiation was.  Dude!  Give it a rest!  A decision I made in 2006 with what information I had can NOT be undone at this point.)

It is one loooooong weekend.  I empty the drains twice a day and hold the measuring cups up to the light.  The urge to fib (just a little) is strong, since the lower the numbers, the faster the drains are removed.  But the urge to do the right thing is stronger, and I faithfully record numbers that are getting dramatically lower on the right while staying unsurprisingly higher on the left.

On Monday I have arranged my ENTIRE day around leaving for Englewood at 10:05, right after I have successfully called in the near-perfect numbers (on the right, at least.)  Quick-ish trip to doctor's office, Yui takes out a drain (maybe 2? No, probably not) and back home again in time to get ready for work and my 1:30 & 2:30 meetings, then school. So the plan is to stay in sweats, etc. until I get home.

Call at 10, get the answering service.  Call at 10:15, get the service.  Call at 10:30, get the service and ask them (nicely) what the HELL is going on over there that they are not picking up the phone after I was PROMISED I could come in "first thing."  They say they'll pass along the message but at this point, I call myself again and reach the office, who says that Yui is in surgery with the doctor, and she'll get back to me.  It is useless for me to explain that I needed 30 minutes' notice to drive over, and did I mention?  It's pouring rain outside.  (You know the saying "Man plans and God laughs?  God was doubled over and peeing in his/her pants by now, I'm sure.)

This poor woman who is taking my calls and probably doesn't deserve the silent verbal pounding I am giving her lets me know, on my (3d? 4th?) call that Yui won't be out of surgery until after noon and Yui passed along the message to ask if at least one of the drains is at 25 or lower?  Yes, dammit.  By this time, my carefully crafted plan for the day in shards around my feet, I am so disappointed that I am crying.  (Did I say that in the scheme of life this is NOT THAT IMPORTANT?  It isn't.  But it sure was then.)

Finally she tells me I can come at 1 p.m. so I throw all my work clothes into a bag, basically pack up for my day into and through Kadimah, which ends at 8:30, and in a couple of trips (no over-working, remember) through the rain, to the car.  I'm leaving early so I can be there, lurking in the waiting room, just as soon as Yui can see me.

As I back the van out of the driveway, I simultaneously realize that a)this is the first time I've driven in 2 weeks and b)the (other) drains, the ones that keep water from collecting around the sunroof and normally channel the water off the back of the roof, are clogged.  So, it is basically raining IN the car as well, but only on the driver's side.  (Really? Come on!)  My left leg is just getting soaked after the water bounces off the steering wheel and on the right the water is dripping right onto the little box we keep in the car for all the extra charging cables.  Meanwhile I am getting onto the highway, which I do not like in normal conditions.  So here we are, cranky, wet, frustrated, tired (always tired) and secretly worried I am going to do all this and get there and she won't take a drain out.  As they say, it would be "all for naught."

After rearranging some stuff with my right hand to protect the electronics, I finally get up to what we could jokingly call highway speed (fog, driving rain, normally horrible fellow drivers even worse) and focus on just getting there.  Arrive at 12:40 and presto!  Yui comes out and takes me in, removes a drain, and verifies that I will have to come on Wednesday to get the left one removed no matter what the numbers are.

By this time, I have surgically removed from my fanny pack the two front pockets, leaving behind a slim pocket just big enough to hold the left drain, so the whole affair can fit "attractively" under a loose top (thank you, Chico's).  I get to use this new setup for not even two days, but any positive change is good.

Wednesday, April 22.  I am seated promptly in the waiting room at 1 for a 1:30 appointment.  I get right in, Yui takes out the left drain, removes some stitches, and says "I'm still not happy with that number (the left drain is "stuck" at 35) so you are going to have to be really careful that the number doesn't go higher now that the drain is out."  Hey, Yui, I love you to pieces, but without the drains and measuring their output, how am I supposed to know if the numbers are getting higher?  She answers my unasked question:  "So, we're going to have to immobilize your left arm - go and get a sling.  You need to wear it for 2 weeks, and come back in a month." (May 27 is the next appointment.)

Okay, so nobody trusts me to take it easy.  Good call.  I head to the drug store, buy one sling of the huge selection (2) that they have (try to get the lightest-weight one) and they patiently work with me to size it and figure out how to use all the velcro to fold bits up and make it work for me.  (Note here that the lovely people at the drug store have never met someone who needed a sling who didn't have a broken hand/arm.) Knowing that everyone will now see a sling and produce a whole new raft of questions, I post the following on Facebook:
"If you see me in a sling, please know:
I'm ok and nothing is broken.
Both drains are out, but qualified surgical professionals don't (with good reason) trust me not to use my left arm for reaching, lifting, and other activities that will harm the nice work they did.

So now they made me wear a sling. It's blue."

With all the nonsense I've been through in my life, I've NEVER had a sling.  It was quite comforting, for a while.  Did its job, and I was secure in the knowledge I wasn't going to overdo because I just couldn't.  That lasted about a 1/2 hour.  Then I realized I've NEVER had a sling.  How do I cut my food? Pull jeans down/up?  Drive?  (Ok, so it turns out I drove exclusively with my right hand for 2 weeks, but that's another questionable decision and it's done now.)  Call to Yui begins with "I feel like an idiot but......."  Turns out I don't have to wear it 24/7 - but I do my best.

Now it's Thursday, May 7.  I started wearing the sling on Wednesday,  April 22 in the afternoon.  So by anyone's calendar it's been 2 weeks. Some people have Cinco de Mayo, some have May the Fourth Be with You.  I have "Fling the Sling Thursday."  I don't think it will catch on and guess what?  I don't care.

Oh oh.  I think I feel fluid building up!  (Just kidding.  I have no idea if fluid did/did not build up more or less in the last two weeks.  And the doctor doesn't want to see me again for another 2 weeks, so methinks he was just being very protective of his work.)  After five years, if he asked me to wear the sling for another 2 weeks, you know I would.  I'd bitch about it, but I would.

Follow up #1

Accompanied (and chauffeured) by ace amazing friend Elyssa, I went for my first post-surgery follow up appointment.  We got in early and were seen in record time.  Today Dr. D's nurse took care of everything, and it was such a lovely visit. I didn't miss the witty verbal sparring that usually comes with time spent with this very smart, talented guy.  Frankly, I had questions, I was kind of physically "pfft" and I just wanted to feel better.  I know I'm not a billion years older than when I had my last surgery, but it seems a little tougher than it used to be.

However: I can now wear camisoles with the elastic support instead of the tight-banded bra.  I can take a shower and soften up the bandages until they fall off. I can wash my hair and wear deodorant! (Doesn't seem like much until you're told you can't do it.) I can sleep, not quite on my side, but what they call "3/4" which I know how to do, requires lots of pillows, and is going to take a load off my back that I've been sleeping (or rather not sleeping) flat on with no movement for the last couple of nights.

I have to continue the every 6 hours valium, I CANNOT get back to my beloved Advil for at least until the drains come out (1-2 weeks) and I can't drive until absolutely all the anesthesia is gone for good, so at least until Monday. I've been told in no uncertain terms that the less activity I do,  the less fluid I'll produce, and the less fluid, the sooner the drains go. (I have to produce less than 30 or 25 ml on each side in a day in order to be free of the annoying but familiar tethers.) No raising my arms higher than the top of my head, no picking up from the floor, no lifting, cooking, etc.  This is by far the most limited in movement I think I've ever been told to be, post surgery.  Remember how I said it feels tougher this time? Turns out it's not me, it's the kind of surgery I had. I am not a billion years older. Woohoo!

But apparently these new snazzy implants are going too be worth it, and he took out all the hardened scar tissue that had formed around the necrotic fat cells. (After years of watching "Bones" and other medical dramas, " necrotic fat" is a part of my everyday vocabulary, isn't that just delightful?)

I will say that I took a quick peek while Yue (the nurse) was un-mummifying me (muttering to herself something about why did they use SO MUCH gauze) and things look a bit more encouraging. Maybe I'll be able to see myself as a "girl" again someday for real! (Okay, even I heard that and I sound like Pinocchio.) But you get my drift.

Seriously, Dude?

As the anesthesia wears off (I'm drinking like crazy because a) you're supposed to and b) you get rid of anesthesia faster via visits to the bathroom) I'm remembering some of what what Dr D'Amico said in Pre-op.   Note that there was no conversation in Post-op.  He didn't come out to talk to Rod either, which is a first.  I know he had a procedure right after me, so maybe that was it.

But it's okay, since I'll see him on Thursday. Undoubtedly we will get the post game then.  And he did put my own sports bra on me in surgery (Huzzah!) instead of the plastic and Velcro surgical bra monster so by the time we get to Thursday afternoon I won't be trying to climb out of my own skin.)

In Pre-op he tossed a couple of curve balls at me.  (One wasn't technically at ME; it was to a nurse: "we will need blah, blah, blah, blah, TWO DRAINS, blah, blah.".

Yes folks, DRAINS, again.  I reacted as you, dear reader, would expect, and I daresay, encourage.  "Drains? Noooooo......."

His (IMHO) casual response was that of course new implants need drains. I told the nurse I had almost broken the record for length of time with drains, and he said that this time would probably only be 1 week "or until the fluid is down." I know what that means; it means as long as it takes. I'll (having thought it over more than 12 hours later) concede based on his previous results.  And after even more thought, realized that the only times I had drains were when implants were put in.

As he drew on me with a purple Sharpie he pitched again, another quick casual one. "And when these settle in for good we'll move a little fat from here (pats general direction of my abdomen) up to fill in spots."

I swing: "B-b-but I thought these new ones are shaped to fill in higher up?" And miss:

"You don't want them too high up, right?" Right. (Again)

But, like always, the long game is what's important.  And thanks to 3 kids, a husband, school parents, teachers, and students, I have cultivated a little patience. Besides, Amazon Prime is right there for me when it wears thin :)

Better Living Through Chemistry - and Chocolate Milkshakes

I'm home and in some "discomfort."  But it's mostly soreness in the muscles I'm sure the surgeon was shoving around while I was out and couldn't whine at him.  My throat (from the tube) "hurts more, actually.  But on the hospital's cute little pictograph of 1 to 10, 10 being what happened on Saturday when I jammed my pinky toe into the doorway of Rod's car while climbing out to get a pedicure (in flip flops, no less) and badly bruising my foot in the place where I broke it over 20 years ago, and 3 being now, after 1/4 of an oxycodone and a Valium.....

God bless Rod and the chocolate milkshake he stopped for on the way home.  And Ari who unpacked my stuff and brought me a strawberry Activia. (Gotta counterbalance that Oxy, and besides it says to take with food.  Milkshake is food, yes?  Of course, yes.)

But typing is a little dicey, what with the pain/meds and all, so suffice it to say I'm home and there's no place like it.  Except maybe Hawaii.  Hawaii is REALLY nice.

Ready or Not...

Passover was great, and somehow here I am, 5 hours until no more food/drink.  I'm just a little stymied by everything, and nothing.  My office at work is tidy, I've laid out all my "hospital clothes" and washed every dirty dish, including the giant matzah ball soup pot.  And with that, Passover cleanup is over.  There are stacks of clean things all over that need to go back to their various cupboards and hiding places until the next "occasion" and I waver between wanting to put them all back and wanting to direct my recovery minions to put them back when I get home from the hospital.

When I get home from the hospital.  When I get home from the hospital.  When I get home from the hospital.  I'm starting to think like Sheldon from The Big Bang Theory.  Knock Knock Knock.  Everything, three times.  What's the magic formula that will give me the confidence to not worry about tomorrow?

No crystal ball, no magic formula, no ability to knock, knock, knock on the door of every single one of tomorrow's medical team and tell them to get a REALLY good night's sleep, for goodness sake.

I can make sure my own personal support system, Rod, gets a decent night's sleep.  The rest is just going to happen whether I'm ready or not.  Who's ever ready for surgery, anyway?

1818

1,818 days.  That is how long it has been since I was diagnosed with breast cancer a second time, and how long the road over, under, around, and through reconstruction and treatment has been.  As of April 9, I will be able to say that the cancer has not recurred for five years, which is something of a custom among people who cannot medically call themselves "cancer-free."

183 days - that's how long it's been since I have written in this blog.  So, you may ask, what prompts this entry?  

Well, last fall I met with Dr. D'Amico and had the surprising conversation about new implants.  And there we left it.  In the intervening months, our health insurance has moved from United HealthCare (who I knew how to work with by now) to Cigna (who I definitely had NO idea how to work with.)  So last winter Marie (Dr. D'Amico's "in-charge" off all things financial) told me that we couldn't do anything until we had Cigna officially and I could get her an ID card, which was January 1.  Promptly after New Year's I faxed a copy of the card over and called the office. 

Since I had met again with him in October, and had decided to go ahead if the (new) insurance company would cover the surgery, all that was left was telephone calls.  Marie called and then the nurse called, and I told them all the times I could NOT have surgery and be incapacitated or otherwise hampered by recovery dos and don'ts (BHSS retreat, RAC trip, Passover seder preparation) and the date was set - April 7, 2015.  It seemed like FOREVER until April.

But a couple of weeks ago the paperwork came in the mail - all the signatures, witness signatures, dates, and initials, plus an appointment for a pre-surgical physical and bloodwork.  Done, done, done.  And now it's April 1 and last night was my last Advil and tomorrow is my first special washing with the antibacterial soap and now it's REALLYREALLYREALLY real.

I've got my Passover supplies and my timeline spreadsheet and that, at least, is under control until it isn't.  The sponge cake could fall, the chopped liver could be "too" something or "not enough" something, the matzah balls could sink...and I wish I could turn off the other worries just for a couple of days.  Just to get my head into the Passover prep game, get revved up about enjoying the evening with my family, and then enjoying the second seder with my family and my friends at BHSS.

I did not take this decision lightly.  Much of the fat that was transplanted to help with the hollows from the mastectomy has, sadly, died, and instead of melting away and leaving, it has surrounded itself with scar tissue.  These are lumps that, oddly enough, are painful.  (Ironic, isn't it?  Completely numb in the reconstruction area except the stupid dead fat thingies.)  At any rate, this tissue is called "encapsulated" and some of the surgery is called a capsulectomy for that reason.  There is also an "implant exchange" (mentioned in an earlier post) and a "flap revision" which I don't know what that is but I'm guessing it has something to do with adjusting everything so it looks all even and (someday) attractive and natural.

Today I heard myself telling someone that it was going to be a good thing, and since the insurance was covering it, not too bad in the expense department, although our new deductible and out-of-pocket are bigger than they used to be.  Am I crazy?  Am I risking my life for a "bargain?"  Is this a bad decision?

I don't think so.  I think that anesthesia is safe, and I think I haven't had a problem with it in all the years I've been having surgeries.  I think that the lumps hurt, and I think I can see them in photos where I'm wearing clothing that is not even that "revealing."  I think the doctor is pretty damn good at his job.  But what do I know?  I know it is scary anyway.