Finally....a surgery date!

Earlier this week I got a date for my surgery. June 11. Two weeks from today. Two weeks is good. Just enough time. Enough time to delegate all my work and get the house ready for my recovery period. Just enough time to get mentally and spiritually prepared.

Two weeks is not enough for me to really freak out too much, either.

Two weeks is just enough.

Pre-surgery visit

I had a visit with my surgeon's nurse practitioner today, basically a pre-surgical intake visit. I got bloodwork, an EKG, and a chest x-ray to make sure I'm in good enough health for the general anesthesia.  I also got educated about how to prepare for the surgery, what to expect the day of surgery, and aftercare.

I confirmed that I will have a lumpectomy on the right breast. I will also have a biopsy done on one of the lymph nodes of the right breast, to see whether the cancer has spread to the lymph nodes. I will also have a non-malignant (but possibly pre-cancerous) lump in the left breast removed. I will end up with three incisions: two on the right and one on the left.

What I did NOT get was the thing I was most anxious to have, the thing I've been telling everyone I would get today: a date for the surgery.

Instead, I will get a call when they have a date for me.

The waiting game is hard. As the impending surgery draws closer, my desire for a hard date grows stronger. The date is my deadline. It's my crap-I-need-to-delegate-my-workload-before-I-leave date. It's my is-the-house-ready-for-post-surgery? and am-I-mentally-prepared? deadline. I feel a great need to know this date, and how much time is left before it arrives.

"Begin to relax with, lean in to, whatever your experience may be. Drop the storyline and simply pause, look out and breathe." Pema Chodron

This is a place for good Buddhist practice. Can I sit with uncertainty? Can I, as Pema says, drop the storyline and relax into the experience? So far, the answer has been not so much, as far as the waiting game is concerned. I will have to work on that.

I am, however, doing extremely well with my needle phobia. I got two vials drawn with no pain and very little fear!  (Well, okay, I did kind of collapse into a little puddle of  relief when it was done. But I got through the actual experience just fine!).

Actually, the most difficult thing about today was discussing the disability paperwork with the nurse practitioner. I dutifully relayed the instructions I had been given by my HR person as to getting them filled out so that the State approves the leave with the least amount of hassle. The NP was incredulous about such stringent requirements and sort of argued with me a little. Finally she laughed and admitted that in the end she'll probably forget my instructions and fill them out the way she usually does. But at least I've done my due diligence!

Benign!

I finally got a call with the results of the biopsy of my left breast. It is benign! That's good news.

I was told that the results would be in 3-5 days after the biopsy, which would have been last Friday or this Tuesday. It's now Friday. I finally called yesterday morning and left a message with the secretary asking for the results. It's frustrating to have been made to wait this long. But, whatever...it's benign!

This doesn't get me out of all surgery on the left breast. As far as I know will still have a surgical biopsy done, on the area of atypical cells in the left breast that was previously biopsied with a needle. But at least I won't have to have two incisions on the left.

I also have an appointment this coming Thursday to schedule the surgery and get bloodwork (I think) and other things needed for the surgery. I have decided to go with "breast-conserving" surgery, i.e., "lumpectomy", which is apparently still an option based on the results of the MRI. Sweet!

I'm happy that things are moving forward!

Adding insult to injury

In preparation for surgery, I have been instructed to stop taking some of the supplements that I take. Some may cause extra bleeding, like Vitamin E and Omega-3 capsules. And some may interfere with the general anesthesia. One of these is St. John's Wort. St. John's Wort is a mild anti-depressant, of the SSRI type. I take it in the winter to help alleviate Seasonal Affective Disorder, aka Winter Blues.

Granted, it's nearly summer now, and I should be letting it go for the year. But REALLY???? I'm going through a major life change, here...I have CANCER, fercrissakes, and I'm supposed to give up my antidepressant?!?

*sigh*

But I'm game. And it's not going as bad as it could be. I have been stepping down gradually over the past 4 weeks. From 3 capsules to 2, then 1, then half a gelcap (open top of gelcap, sprinkle out half the powder), then a quarter gelcap. Each time I step down I have a couple of days of random weepiness and crankiness, then a couple of days of low, but gradually improving, mood. By the fifth day I am feeling back to normal. Day six is a happy day. Then it starts all over again.

I took my last quarter gelcap two days ago. That's it. No more St. John's Wort. This last time, having already gone through four cycles of sad days, and knowing there was one more coming? That took some inner fortitude. Yesterday was not great. Today I am feeling better. Knowing this will end and I will feel normal by Thursday is very good. I spent a lot of my younger years depressed, and the feelings I am having now are oh so familiar. I do not miss those days.

I have a meditation planned for this afternoon, and that will help. And I will see if I can get out for a walk in the sun in a bit. Also very therapeutic. But if you were at the party I attended last night, and I seemed down? Now you know why. Sorry about that. :-)

MRI guided biopsy

“We either make ourselves miserable, or we make ourselves strong. The amount of work is the same.” —   Carlos Castaneda

The MRI-guided biopsy went quite well, actually. The meditation and relaxation techniques I have been practicing worked well to help me get through the experience without too much stress. Not only did I cope much better with the pain of the numbing shots and IV of contrast fluid, but to my surprise, my subjective levels of pain were less! Quite a bit less, actually!

I wore my Frida Kahlo socks, for strength. 

Just as for the MRI two weeks ago, I lay on my belly with my arms over my head. The main difference was that this time the right breast was squished behind a plate to get it out of the way. The left breast, the one that was being biopsied, dropped through a hole in the bed, where it was clamped between plates like for a mammogram. The doctor worked on the breast from the side. Like in this picture, except my face was pointed down, resting on a face cradle.

(image from www.appliedradiology.com)

The MRI technicians did a series of scans, both without contrast and with, so they could hone in on the area to be sampled. This time I asked for earplugs, and the scanning process wasn't bad at all.

I was wheeled out of the machine, and the doctor started prepping me for the biopsy. All this time I had to remain completely still so as not to shift the sample site out of the "crosshairs", so to speak. (Before I was taken to the MRI room, the doctor had told me the MRI scan from two weeks ago had seen a "tiny spot" that they wanted to sample. I was all..."Tiny? Tiny is good! I like tiny!")

This was my third biopsy. The worst part for me, every time, are the numbing shots. I hate shots. This time I had my calming mantra to sing internally to myself with each breath. It worked really well. I swear the shots hurt less than they had before. I winced a couple of times, but after that it was okay.

When the core biopsy needle was inserted, I did feel a little bit of sharp pain as it came to the final position, and asked for more numbing. Before they actually started taking the samples, I was wheeled back into the MRI machine for a final scan, just to make sure they were at the right spot.

The samples were taken very quickly...it was over before I knew it. They inserted a titanium chip that will show up on a mammogram, then wheeled me back into the MRI tube for one final check that the right area had been sampled.

And that was it! The technician kept compression on the incision for 15 minutes, during which time I slowly began moving my arms, which were stiff from being held overhead for an hour or more. The last 10 minutes in the scanner things were getting pretty uncomfortable. My cheeks were sore from being pressed into the face cradle, and my shoulders were started to get pretty sore as well. I was so relieved when they finally told me I could move again!

Now another waiting game. The results should be in by early next week. Nothing to do now but wait, and recover from the biopsy.

Meeting the radiation oncologist

Thursday morning, I had a meeting with Dr. White, the radiation oncologist who will be overseeing my radiation treatments. I liked her. She was very pleasant, explained everything in good detail, and politely waited for me to ask questions. She answered all of my questions about what about what to expect from the radiation treatments.

The radiation treatments start about 6 to 8 weeks after the surgery, once my breasts have healed. I'll have 30 treatments, one per day Monday through Friday, for 6 weeks. The radiation is targeted right at the points on the breast where it is needed. The treatment itself will last about 20-30 minutes, but she said to expect to be at the breast center about 45 minutes. Once a week I will meet with her to see how things are going. That will add about 15 minutes to that visit.

I learned that everyone has some side effects from the radiation. The breast will get red and tender like a sunburn. Most women don't have any real pain, just tenderness. After about the third week you generally get progressively more tired during the day, the last week being the hardest. Dr. White suggested I work 6 hours a day during the time I'm getting radiation. Leave work at 3:30, go to the breast center for an hour, then go home and rest. I'm on board with this.

One good thing I learned is that the radiation treatments tend to change the breast tissue, making it less lumpy, dense and painful. That is great news! That means that future mammograms won't be so difficult, and I may not need so many views or follow-up ultrasound/MRIs. That's one more tic in the lumpectomy column (vs. mastectomy).

But the neatest thing I learned during my visit was learning that blood oxygen saturation can be detected using a device that slips over your finger! The device is called a pulse oximeter. It detects how saturated the arterial blood is with oxygen. Mine was 100%, meaning that all hemoglobin binding sites were filled with O2. (This is good, by the way.) It blew my mind that could be detected through the fingertip. Apparently the sensor measures absorption of different wavelengths of light to make the measurement. Totally cool!

MRI results

It took over a week to get the results of the MRI. It turns out the nurse practitioner was on vacation last week. I thought that might be the case, with the Memorial Day weekend, and all.

I finally called her on Wednesday. The MRI found a "suspicious" structure in the left breast (I don't remember the exact term, but it was pretty vague). This area is in a new location that they hadn't seen before. The doctor wants to biopsy the area to determine whether it is cancerous. I am scheduled for an MRI-guided biopsy this coming Wednesday (because clearly the pleasure of a biopsy isn't enough...this way I get to experience the joy of both biopsy and MRI!).

No, really, I'm glad it is being biopsied. Best to be sure. I only wish the MRI had been ordered earlier in the process, before I got the earlier biopsies. My breast tissue is so dense that mammograms can have difficulty seeing through it.


Now that I know what to expect from the biopsy experience, I don't think it will be as difficult for me as the previous ones were. This means another round of waiting for test results, though. The waiting is the hardest part of this. Is it cancer? If so, will it be as easy to treat as the other malignancy? Or will they say the dreaded word: "chemotherapy"?