Two Weeks Post Surgery – August 27, 2015

It’s been 2 weeks since my surgery!  I was a pretty good patient and tried not to use my right arm at all for the 2 weeks in order to prevent lymphedema.  Let me back up.

The morning of the surgery, I reported to the Breast Imaging Center so that a locating wire could be placed in my breast to the clip which was inserted at the tumor site before I started chemo.  Then I was carted over to Nuclear Imaging so that a radioactive tracer could be injected into my breast, to help with the identification of lymph nodes. I will tell you that little injection hurt like nobody’s business – so much so that the nurse told me I could squeeze her hand as hard as I needed.  Fortunately the pain was short lived.  By then we were running late, so I was taken in almost right away at the Surgecenter, and my sister (who drove me) couldn’t come to visit.  After vitals were taken and I dressed for surgery, the anesthesiologist came to see me.  I knew that the surgery was scheduled for 3.5 hours, which meant I’d likely have heavy narcotics for the anesthesia.  So I warned the doc that I don’t react well to anesthesia.  He thanked me for telling him and said he would take extra precautions; we then discussed getting a patch which I could leave on for 1-3 days to help with post-surgery nausea.  I agreed, and shortly after the anesthesiologist left, I got a visit from Dr. White, my plastic surgeon.  He then “marked” me for the surgery, taking measurements and marking my breasts with a Sharpie.  Then Dr. Ching came in to check on things.  She reiterated that the surgery may need a follow up surgery if there aren’t clear margins from what she was going to remove.  I told her I had faith that everything was going to be fine – that I’d need only one surgery.

Soon thereafter I was wheeled into the OR, where the anesthesiologist was waiting.  I was out just a few minutes later, and woke up in recovery four and half hours later.  Dr. Ching came out to talk to my sister and let her know that everything looked good; she removed 3 lymph nodes in addition to the tumor area and a few other areas. Ted arrived at some point so my sister could go to work, and so it was Ted who joined me in recovery.  About an hour later I was ready to go home.

Despite the patch, I had nausea for the next day.  I finally decided to remove the patch and since I wasn’t in a ton of pain, to switch from Percocet to Tylenol.  Once I did that, the nausea stopped although I had very little appetite.  I’ve also had diarrhea pretty much since my last dose of chemo on July 31, and 10 days of antibiotics did not help. The diarrhea continues, but I’ve started taking Imodium again and that’s helped.

I’ve had experience not using my right arm before; in November 2011 I had right shoulder surgery.  My arm was in a sling for a while, although I was not 100% compliant, I know what it’s like to have to use my non-dominant hand for everyday tasks.  At least I didn’t have to worry about brushing and washing my hair one-handed! Actually, I wasn’t allowed to take a shower until my first post-op with Plastic Surgery, exactly a week after my surgery.  I tried my best not to use my arm, and since I was banned from using the computer, I’ve discovered the joys of Netflix and Amazon Prime streaming.

On Monday the 17th, 5 days after surgery, Dr. Ching called me with the pathology results.  The news could not be better:  NO CANCER ANYWHERE!!  The tissue removed around the tumor site showed all signs of having been changed from chemo; the additional areas removed had no cancer as well as the 3 lymph nodes removed.  No second surgery is needed.  Dr. Ching said that I was one of the rare people who is a complete responder with chemo, so all those months of chemo were totally worth it. It feels really great to know that I don’t have any cancer!

You might ask if that means my treatment changes at all, and it does not.  Because I chose a lumpectomy rather than mastectomy, I will still need radiation (for 5-6 weeks) and I still need Herceptin (targeted chemo) until May or so.  But to know that I have no more cancer has been the best news since, well, December 15, 2014.

My best friend Kim took me to my first post-op, after which we went to lunch.  After a lengthy surgery and a week of doing nothing, it was amazing how much that one little outing tired me out.  I went to bed very early the next two nights, sleeping a lot more the following day.  That told me that the surgery – and 6 months of chemo – has really taken a toll on my body, and it’s best if I rest as much as possible during my medical leave.

On Monday, I had an appointment with Dr. Ching, to which my friend Kim took me again.  Dr. Ching said that my breasts looked great.  I admitted that I hadn’t been 100% compliant about not using my right arm, and she said it was okay – that they tell patients not to use it at all, expecting not 100% compliance but maybe 70%, and that was actually enough to prevent lymphedema. Since I didn’t have lymphedema, and things were looking good, my next appointment with Dr. Ching is in six months.

I got clearance to be able to use a computer, knit and drive, so today I drove myself. First thing in the morning I had a blood draw because I’m scheduled to have Herceptin tomorrow, and then I went to Target to pick up a few things.  I felt faint in Target, another sign that I need to take it easy while building up my strength.  I came home and took a nap.  Naps are good.

I had another post-op with Plastic Surgery in the afternoon.  Dr. White came in to see how I was doing, and he seemed pleased with my progress.  I asked him about some areas which seem to “pooch” out; Dr. Ching mentioned that Dr. White could liposuction those areas.   Dr. White said he could but wants to wait for 6 months, when things should finally settle down from the surgery.  Then the PA removed the plastic bandages which covered my stitches. The stitches will eventually dissolve, but as the swelling recedes, some stitches get uncovered before dissolving.   The PA trimmed some of those, removed the glue using a type of “Goo Be Gone” for the skin, then dabbed antibiotic ointment around my scars.  She wants to see me a week before we leave for Maui, because if my scars aren’t closed by then I won’t be able to swim.  😦  Otherwise, I don’t need to see Dr. White again for 6 months.

I then went to Oncology:  I had an appointment with Dr. Priya, in which we mostly chatted about my nieces and nephew, and the pressure on high school students.  That was after we discussed that my magnesium was low (I’ll get 2 gr tomorrow), and that I can get my teeth cleaned now.  I told her that I was going to get an implant for the infected molar which was removed, and she told me to put it off until next year. I asked her why, and she said that with the chemo, surgery and radiation that she wanted my body to recover before getting an implant.

So how do I feel?  There is soreness in my right armpit, where the lymph nodes removal scar resides.  There is tightness around the scars under my breasts, and I need to wear a bra 24/7 (or as much as possible) for at least another week.  I’ve tried not wearing a bra, but after a few hours, my breasts get sore and tight, so a bra helps.  At least I can switch to a sports bra, or a camisole with a bra built in.  The bra which I received post surgery provides more compression than support, and I was getting tired of it.

Nerves were all messed up and jumbled during surgery, and it takes about 6 months for them to figure out what they should be doing.  What that means is there have been nights when I’ve been woken up by a shooting pain in my breasts.  It happens during the day, too, but when you get woken up by sudden pain…well, it’s just surprising.  At least the pain isn’t constant or all that painful – it’s more of a shock than anything else.

A work colleague set up a Meal Train for us for the past 2 weeks, and it’s been a big help for Ted not to have to cook in addition to taking care of me and the boys (our 4 cats). The generosity of people never ceases to amaze me, and I am ever so grateful for all the support we’ve received.  In addition to the Meal Train, I’ve gotten 3 beautiful bouquets of flowers, a gift certificate for dinner delivery, chocolate covered strawberries, homemade cookies, numerous get well cards – the list goes on.  I am a bit overwhelmed at my “village” and thankful for all of you in my life.

I plan to continue to rest as much as possible, but to start to resume some activities. After all, football season starts next week!  Fall is my favorite time of year.  I hope radiation doesn’t take too much out of me; I start in October and hopefully I’ll be done by Thanksgiving.  I’d love to host Christmas this year!

Twas the Night Before Surgery – August 11, 2015

Just a quick post.  Everything starts tomorrow at 8 am.  I have to go to the Breast Center for a wire localization procedure, and then at 9 am to Nuclear Medicine, where a dye will be injected.  The dye is to help identify lymph nodes. Then I report at 10 am to the SurgeCenter; my surgery is scheduled for 11 am.

The surgery is scheduled for 3.5 hours, and then I’ll be sent home.  I’ve picked up antibiotics and pain meds (percocet, my drug of choice!), and had some blood work and an EKG.  A small moment of panic when I received a call from Dr. Ching’s office informing me that my EKG was abnormal and my primary care physician needed to okay the surgery given the abnormal EKG.  My PCP did authorize the surgery, explaining that the result wasn’t so much abnormal as it was different from the last one I’d had.  Whew!

I will remain in the dressing that I’m sent home with for a week, when I have my first post-op with Dr. White’s (plastic surgeon) office.  Hopefully by then the drains can be removed (i.e., I’m draining very little) and I can finally take a shower.  My first post-op with Dr. Ching is the following Monday, when I will hopefully get the release to be able to drive.  I have chemo that Friday, so it would be great to be able to drive myself rather than bother family and friends to be my chauffeur.

Someone at work set up a MealTrain for Ted and me.  It’s a way to ask folks to provide meals for us – very cool!  Folks can drop off home cooked meals, or provide gift certificates for DoorDash, Munchery or the like.  This will relieve Ted from having to cook AND take care of me for the next couple of weeks.

Wish me luck!  While I’ve had 5 prior surgeries, those have all been orthopedic in nature – this one will be very different.  I understand that hardest thing to adjust to is nerves firing, not necessarily soreness as from surgeries which cut into muscle. I’ll find out soon enough!

Moving Fast – August 1, 2015

Things are moving right along!  My surgery is scheduled for August 12.  I’ll have the surgery which was originally planned for in January, which is a lumpectomy (aka segmental mastectomy) and a lift on both breasts.  While the plastic surgeon is doing the lift, Dr. White will also remove a lipoma (fatty, non-cancerous mass) on my left breast.  That lipoma is probably the reason I didn’t think much of any growth I felt on my right breast during self-exams, so thank goodness for annual mammograms.

I’ve already received the surgery instructions, and I was sent a microbial soap with which to shower on the morning of my surgery.  I think it’s the same soap that surgeons use to scrub before a surgery.  Prior to the surgery, I have a needle localization procedure done, and then Nuclear Medicine will inject a dye to help identify the lymph nodes.  The paperwork currently states that Dr. Ching  will remove the sentinel node and possible removal of axillary nodes.  I thought that because I had chemo first, that Dr. Ching was going to remove more than the sentinel node for sure, so I’m cautiously optimistic that perhaps fewer lymph nodes will be removed than I thought.  The more nodes she removes, the higher the risk of lymphedema.  The lymphatic system is the body’s garbage removal system, and removing nodes can cause a blockage, resulting in swelling, or lympedema.

Prior to August 12, I’ll need blood work (surprise, surprise) and an EKG.  I’ve had both, so no sweat.  I’ve had 5 surgeries – all orthopedic in nature – so I know that when I hit 40, an EKG was required.

This is the first update in a while – things have been very busy.  We went live with the new database system on July 15, a 2 year project to convert from the previous database.  There is the inevitable shakeout from a system change, but all in all, the conversion went fairly smoothly.  In the meantime, I have been preparing for a conference of which I am the chair.  I leave tomorrow morning at 6 am for Boston and return late on the 8th.  We are moving my mom to a residential care facility that weekend (thank you Ted for helping on Saturday), I go to work for 2 days, and then my surgery is on Wednesday and I’m off work for 7 weeks (6 weeks leave, 1 week vacation). After that, though, the second big hurdle in my treatment is complete, and I will admit to a bit of excitement about the progress.

Yesterday I had chemo.  Yes, chemo.  While I am done with Taxol, or what I’m calling “general” chemo, I still have targeted chemotherapy.  Dr. Priya wanted me to take full advantage of getting approved for Perjeta and gave me a 4th dose yesterday, and I also received Herceptin, which I will need to receive until probably May at this point.  I also received magnesium, but only 1 gram – my magnesium level is finally climbing back up. It was actually really great to see all the chemo nurses – I’ve gotten to know almost all of them and they are wonderful.

Targeted chemotherapy is not immuosuppressive, which means, theoretically, that my blood counts should be on the rise back to normal.  Indeed, my hemoglobin was 11.4 without the help of a blood transfusion, and all other counts are heading to normal  (in case you’re curious, both Perjeta and Herceptin are monoclonal antibodies.  Each targets a particular part of the HER2 cancer and blocks the HER2 receptors.)  The nature of targeted chemotherapy allows for me to get chemo just 12 days before surgery.

Of course, I had to have some last minute excitement…my left ankle has been swelling the last few days.  A few weeks ago, both ankles were swelling, but after a week of sleeping with my legs elevated the swelling went away.  Because the swelling was only in one ankle, I had an ultrasound to rule out a blood clot (aka DVT, or Deep Vein Thrombosis).  Typically swelling resulting from chemo would be in both ankles, hence the concern.  The ultrasound was negative for a DVT, though, so I guess I’m having yet another unusual reaction to the Taxene family of chemotherapy.  There is a little concern because I’m flying tomorrow, but I’ll wear the ever sexy compression stockings and continue to sleep with my legs elevated.  The good thing is this morning the ankle is almost back to normal.  We’ll see how it is after a day of activity today.

I am excited for my trip!  I am transporting a 13 week old Siamese kitten to her mom with me, and then I get to spend a week with 6 fabulous colleagues.  We have almost 100 participant registered – a 50% increase over last year – and we will be in one of my favorite cities.  I am doing a visit with one of the vendors we use, which will be really fun, and then I get to geek out with like-minded folks.  This conference is my favorite: while it’s not an insignificant amount of work and energy, it is also the most fulfilling because you really get to know the participants.  You’re with them for 5 days, working with them on team projects, and seeing the same folks in sessions.  There’s time to socialize and get to know each other in that way, too.  It’s the first time (for me) this conference is in a more urban surrounding, so I’m curious how/if that changes the nature of the conference.

I probably won’t post again until after surgery, and since my arm movements are restricted for a couple of weeks, it may be awhile!  I’ll take all positive thoughts (and prayers, if you’re inclined) that everything goes well!