Phase 2: Surgery

As promised, I have more details on surgery and will be sharing them today. Surgery is scheduled for 11/3 (election day). When I let my oncologist know, he was like GREAT, I look forward to celebrating two amazing outcomes that night. I'm glad he is optimistic! My first thought was that Chris was going to die of a heart attack while I was at the hospital between stress about me and stress about the election. I know he is going to be watching all the live coverage and yelling at the TV and generally raising his blood pressure.  Who knows, though, maybe it will be a good distraction for him.  For me, it will be weird to sort of miss that moment with the rest of the world, but maybe good for me, too.

Since chemo, I have been BUSY with pre-surgery appointments. Because the cancer showed up on the skin, my surgeon had me come in this past Monday (10/12) so she could take skin samples and have them biopsied before surgery to ensure she was getting clean margins. She took four skin samples, gave me four sets of stitches, and from those initial samples, 3 were cancer-free. The one at the top of my chest (closest to the tumor, as well as my heart and lungs, eek!) was not. So I went back yesterday and had two more samples taken, two more sets of stiches, and those were both clean so she now has the line for the surgery, which is reassuring and amazing news! Also, how super smart to take the samples before surgery???? Usually they just do the surgery and do their best for clean margins, but if we had done that, I would have had to go back under for a second surgery because the original line of incision would not have been clean. I am so grateful to have such smart people on my care team, who are also really collaborative and open to learning and trying new things. I think it will result in overall better outcomes for me.

I've also had two consults with my plastic surgeon and a follow-up with the radiologist, so that we are all on the same page about the surgery.  Here is what will happen:

1. The Oncology Surgeon (Dr. Mitchell) will remove the skin, implant, and tissue leftover from my original surgery in 2014, as well as all the lymphnodes in the left armpit. Her job is to get out all the cancer.

2. The Plastic Surgeon (Dr. Soares) will be doing three different things, and his part of the surgery will take longer. 

• First, while Dr. Mitchell is working on the left side, he'll work on the right side, remove my implant and replace it with a small over-muscle tissue expander so that the radiologist doesn't hit my skin on the right hand side when I do radiation in December. 
• Second, he will be attempting a procedure that helps to overcome the risk of lymphedema that might result from all my lymphnodes being removed from my armpit. He'll be looking for a vein in my arm that can be re-routed to connect to the lymphatic system to pick up the drainage being impacted by the removed lymphnodes.  There is an actual medical name for this - I don't know it - and I may not even be describing it well, but it's effective in 85% of cases, so I am hopeful. This will help me continue to maintain as much mobility and activity throoughout the rest of my hopefully long life as possible.
• Last, he'll close me up and things get a little tricky. Dr. Mitchell will be trying to take as much skin as necessary to get the cancer out, but also not too much so that my skin can be sewn together to close me back up. If they are able to do that, then Dr. Soares will just close me up like he would any surgical incision. There is a 50% chance he'll be able to do that. If there isn't enough skin to close me up, then he will be performing a lat flap, meaning creating an incision around my side and taking my lat muscle and stretching it over the chest in order to provide skin to close the opening. There is a 50% chance that will be necessary.  If that is the procedure needed, word on the street is that I will premanently lose about 15-20% strength on my left side and may not be able to perform certain activities (push-ups, rowing, climbing...) which will be sad, so I am hopeful he can just close me up without the extra step...but I also want all the cancer out for good this time, so I am fine either way and will deal with whatever it does to my long-term mobility.

All of this stuff can apparently be done in about 4 hours, which is also quitre remarkable! I will stay in the hospital for one night, and then be on bed rest for about three days, and limited mobility for 4-6 weeks. I'll have multiple icky drains. I will be on lots of meds (might be the most mellow days of my life!). But I will be just healing before I move into Phase 3 Radiation.

So I think that's it. I hope I wrote that in a way that wasn't too gross but provided enough detail to explain why I am terrified.  Oh - also, I have to get a damn up-the-nose Covid test before surgery and that is also terrifying so MEGA BOO to stupid Covid!

What's making me happy:

• Next week, we are going to Pismo for 5 days for a change of scenery since we have taken ZERO vacations in 2020 and have diligently been sheltering in damn place since mid-March due to Covid. I can't remember if I shared here, but we thought I would have the whole month of October off and thought about traveling through several states and hitting up several National Parks on a one-month road tour. Then, I had the liver issue with the second stage of chemo, and chemo got delayed a week, so we stopped feeling confident about scheduling anything. Toward the end of chemo, we had reduced it to a 3-week trip to Utah to see their five National Parks, but then my surgeon mentioned pre-op appointments, and I have monthly shots of Lupron to shut down my ovaries and needed to be here on 10/27 for that, and they thought I might be able to have surgery in October, and Covid cases started spiking in Utah, so a long out-of-state trip stopped feeling realistic. Last week, we ended up booking the one house still available that looked nice in Pismo which was available for the five days remaining in October which we had free. I booked a private kayak tour since it might be my last time kayaking. We'll go see the monarchs, and hopefully have s'mores on the beach, and just feel normal for a few days. So, I'm excited for five days - which are of course not as amazing as a month-long road trip - but better than nothing!
• Peloton Outdoor Power Walks: When our hiking trails shut down because of high fire risk, and we'd hd bd air quality for days as well, I just stopped walking at all and it sucked. My sisters have been talking up Peloton for months, so I downloaded the app and have been doing these guided 45 minute power walks and I totally love them. I feel super self conscious about doing the dorky power walk arm swing, but the instructors tell me I have to, and so I do. The first few have made my butt sore, and I think it's been a good add to my workout regiment, especially since there have been several days when I can't do my normal workouts becuse of stitches and things.  (I am going to REALLY STRUGGLE to not workout after surgery! Eek!)
• My surgery "success" guided visualization: The cancer therapist I work with who gave me the great visualization for my scans, created a visualization for my surgery so I am listening to that every day and visulizing a great outcome~!
• The idea of becoming a Breast Cancer Advocate. I reached back out to the postpartum breast cancer specialist who I had the consult with (Dr. Borges) and asked her what needs their might be for a former recruiter with program management skills and a 16 year old MPH...and she suggested I look into getting the education and training to be a breast cancer advocate, and is looking for someone to join her team part-time. A breast cancer advocate is the voice of the patient in advocting for funding, research, legislation related to breast cancer. I think it sounds perfect so I plan to look into the courses necessary to do this. And, it's the kind of job you can work around your regular job, so we'll see if this helps me put all the pieces together of post-cancer 2.0 for my life. I can't imagine what that feels or looks like yet.
• I am back to reading and exploring new shows - let me know if you have recommendations for either. I am going to need things to fill my time after surgery!

I think that's all I have for tonight.  Thanks for reading!

Sherri

Phase 1: DONE!

Well, it's Tuesday, and guess what people?  I don't have chemo today because PHASE 1 IS DONE! 16 rounds over 21 weeks with bloodwork every Monday, chemo on Tuesday, and for the last 4 rounds, white blood cell booster shots every Wednesday, Thursday and Friday. This week my calendar is pretty much empty and I have the freedom to decide how to spend the next month before surgery, which feels awesome.

In EVEN BETTER NEWS, the post-chemo scans showed that the cancer was "very responsive" to the chemo, with the visible cancer in the armpit being completely resolved and the cancer in the chest being 90% resolved before the last chemo (so hopefully even more after the last chemo.)  Let me just say a SUPER LOUD AND ENTHUSIASTIC PHEW AND WAHOO! 16 rounds of chemo were a marathon. It felt long and like a massive hamster wheel. I was and am super tired. To know it was worth it and the cancer responded is a massive relief.  Thank you to my body for physically tolerating it so well!  I love you, body!

If you aren't already clapping and whooping it up in front of your phone or computer screen, why don't we pause for 20 seconds and give you a moment to appropriately celebrate with me...(pause for 20 seconds...) THANK YOU for feeling that victory dance with me!

 If I was listening to my cancer therapist I would stop the blog right there. She has been working with me on relishing the good moments in life - taking them in, making them last, REALLY noticing them, and I did not live up to this guidance on my last chemo day. My friend Kate sent me a lovely bouquet of flowers, my friend Yvette called to give me a live YAHOO when I texted her about the scans...and MANY other friends, my sisters and mom texted with their congratulations knowing it was my last chemo. It's wonderful to have other people remember the milestones I'm crossing and remind me to celebrate progress! But, the Cancer Center doesn't have a ritual for the last chemo, so no bell to ring or departure song or anything like that. I brought them a box of See's candy lollipops with a thank you card for "seeing" me as more than a cancer patient and expressing my hope to never see them again (for real!). (It was hard to think of something that met all the Covid restrictions, but these are individually wrapped in a cellophane box, so worked.) 

When I got home, the subacute center where my mom is being treated called me seven times with things they needed, Natasha had her basketball skills training, we had no dinner plan, and life just resumed as it always does which was sort of frantic and messy and needy. We got takeout of my choice for dinner which I ate alone in the backyard as Chris watched the Presidential debate and the kids zoomed and played video games with friends. I moved straight into GO MODE for Phase 2 - surgery...and honestly, could just feel the new wave of anxiety setting in about all the scary, complicated surgery details.

So...I'm trying to sort of slow my roll right now against my inclination to fast track into surgery mode and enjoy the month ahead. Yes, there are more medical appointments before surgery and the truly terrifying task of having the swab up the nose test to make sure I am Covid negative before surgery. But, I have about 30 days or so to relish the pause between phases and I am really trying against every natural instinct in my body to relish this time and not spend it agonizing over surgery details and what-if scenarios.  It's hard. It doesn't come naturally for me...but I am REALLY TRYING.

The details of my surgery are still being sorted out because the cancer on the skin is unusual and tricky. I will likely need what they call a lat flap, which is using my lat muscle to pull into the chest area in order to close my skin together. Before surgery I need to have some additional skin removed and biopsied so they can work on clean margins with the skin removal, I need an EKG, the surgery has four different parts happening simultaneously, I will likely permanently lose 15-20% of strength in my left side...etc., etc.  See - Do you see how easy it is to slip into taskmaster go mode and anxiety overload? Ahhhh - I tell you what, I'll do another blog post after my October 12th biopsies when I know all the details about surgery and for those of you who like the details or are interested in the medical stuff, I will share everything I know then. (And, also, despite the fact that the cancer was super responsive to chemo, there is no way to detect cancer at the microscopic level through scans, hence why surgery and radiation are still needed to make sure they got everything, including at the microscopic level.)

I hope to spend the next month focused on two main things:

1. Getting as strong as possible for surgery. This will be an intense focus on exercise, sleep, meditation, healthy foods, anxiety-management, guided visualizations, and meditation. The recovery from surgery will be 4-6 weeks and I won't be able to exercise or do normal tasks for much of that period so I am getting myself in the best shape I can so my recovery and resumption of normal tasks is as easy as possible!
2. Relaxing and being present. I have returned to reading mode and hope to get through the eight or so books I have stockpiled which I neglected when I got too tired to focus on reading during chemo. While we had grand plans to do a driving tour of Utah during my down time, because I still have quite a few appointments this month before surgery, we are looking at doing a week-long getaway probably in Pismo Beach, enjoying a different set of walls and rooms, walking to the beach after virtual school and just escaping from the normal everyday grind of Covid + cancer. I need to get in some kayaking and stand-up-paddleboard before surgery as those types of movements might forever be restricted, and I love both of those activities and don't do them enough. I want to hike and play with the kids and eat good food. Oh, and someone gave me a bottle of Dom Perignon in thanks for a Sonos discount code so I am enjoying that for sure!

Oh - before I go I need to remind everyone that October is Breast Cancer ACTION month. We are so far past awareness at this stage, and I encourage you all to take some action toward a world free of breast cancer. I believe the common sentiment about breast cancer is that it's the "good" kind of cancer, and survivable and so people sort of dismiss the severity of it.  Don't be that person.  Breast cancer is SO PREVALENT. I think it's like 12,000 women a year die of breast cancer, which makes it something like every 13 minutes.  Last week, two friends I adore made me aware they had recently been diagnosed with breast cancer.  It happens too often. I know too many people who have had it or have it now. Many of the available treatments permanently alter a woman's chemical make-up in order to keep the cancer at bay, the surgeries remove whole parts of women, the fear is always there even if mostly subconscious and not interfering in day to day life. While it seems the "formula" for breast cancer treatment has been perfected, a lot of the individual cancers, like mine, are tricky and unpredictable and there is some guessing and luck involved. Funding is super important! Your self-exams (women!) are important - both times I found the cancer myself and had to be pretty aggressive to get quick exams and treatment. The two organizations I am most excited about with regard to breast cancer research are the Susan Love Foundation (in Encino, CA) and the National Breast Cancer Coalition. Make a donation or consider joining the Susan Love Army of Women - no cancer diagnosis required - to actively participate in breast cancer research!

I'll leave you with these two quotes which have inspired me since my first diagnois in 2013. I hope they inspire you as well. If not before, I will be back around the 12th with more details on my surgery.

As always, thanks for reading and thanks for the support!

Sherri