I haven’t written much about surgeries lately. Well, truth be told, I haven’t written much about anything lately. But certainly not about surgeries. Despite the double-digit number of surgeries I have had in the last five years, I don’t like being cut upon or tweaked or refined. I’m good with my rough edges. My body has other ideas, however.
At the beginning of this year I had reached my limit of tolerance for the carpal tunnel pain & suffering so I consulted a well-respected hand specialist and got a nasty surprise. In addition to carpal tunnel, I also had cubital tunnel syndrome (I’m an overachiever that way), so the no-big-deal surgery to correct the issues in my right wrist morped into a full-blown ulnar nerve anterior transposition. It looked like this:
Long story short, the ulnar nerve (which runs from one’s neck to fingertip) becomes dislodged and gets caught on the bony ridge of one’s elbow when one stretches or bends at the elbow. Once dislodged, the nerve needs help getting back in the right place. So, my surgeon had to dig a new channel for my ulnar nerve to lie in, then stitch the nerve into the muscle to ensure that it didn’t go rogue again. It was as pleasant as it sounds (not really pleasant at all). And the scar is about as pretty as you might expect (not really pretty at all). It’s a good conversation piece, though; I’ve been asked more than once if I had Tommy John surgery (do I look like a baseball pitcher?) or whether I won the knife fight.
Now that I am recovered from the fun & games of my arm surgery, it’s time to get back on that OR table and get myself a new knee. Yes, a total knee replacement at the ripe old age of 46.
Don’t be jealous.
I’ve been dancing around the knee issue for years. After two arthroscopies, a lateral release and minor ACL repair, a PRP infusion, and 11 injections of synthetic synovial fluid in the last 10 years, it’s time. The x-rays that show zero cartilage say it’s time. The grinding of bone on bone say it’s time. The uncertainty of being able to get up from a crouched position say it’s time. The increased pain, decreased mobility, and off-the-charts frustration say it’s time.
I’m not looking forward to this.
That said, I am intrigued by the particulars of an artificial knee; the one I’m getting is cutting-edge. It uses a proprietary Oxinium (oxidized zirconium) on the femoral part of the joint, a PMMA plastic on the tibial side, and a stainless steel piece to add a little sparkle. That oxinium is pretty cool; it’s a metal alloy that once heated transforms into a smooth surface that is super resistant to wear & tear and is much lighter than the metal used in older versions of knee replacement devices. It is free from nickel but will likely still set off the metal detectors at the airport. Fingers crossed that the TSA person who gives me a pat-down is gentle (and cute).
The combo of Oxinium and PMMA plastic are the Wonder Twins of knee replacement devices. Rumor has it this combo can last 30 years. That’s important when one is on the flat end of the bell curve that represents the average age of a knee-replacement recipient. As is my custom, I’m way ahead of my peers in my medical needs. Like 20 years ahead.
Being the weirdo that I am when it comes to surgeries, I like to gather all the gory details about the procedure. I usually watch a youtube video of an actual procedure, too, but usually after I’ve endured the horror of the real thing. Here’s how it will go down: Amy doc will make a vertical incision, probably between 6 and 10 inches, on my bum leg. Once in, he will move my kneecap so he can get to the leg bones. He’s going to cut my femur and tibia (if you’re strangely curious as I am, may I suggest that you don’t google “orthopedic bone saw?” That’s just creepy. The fact that such tools are available for purchase on eBay is even more creepy). He promised to measure twice and cut once. (Because the pieces that comprise an artificial knee come in some 90 sizes, I hope he measures more than twice!) Once the bones are cut, he will shape them to accommodate the new pieces that will make up my bionic knee and will attach the pieces to the bones. Then he will attach the parts to the kneecap, using bone cement. My doc told me that waiting for the cement to dry takes nearly as long as the rest of the procedure. Then he will sew me back up and once I’m awake and somewhat coherent, I’ll be off to my hospital room.
Most patients stay three nights in the hospital, but I’m already hoping to ditch out early. I’ve spent enough nights in the joint. I’m fortunate that my doc has a swanky surgery center not far from my home. There are only 5 rooms, which is good because I have no business mixing and mingling with the gen pop in a regular hospital. I hear a lot of people get really sick in hospitals.
Ten years ago today, I got the call. The call I’d been dreading. The call from my dad to tell me that my mom was dead. I was in my car, in line to drop my #1 son at school. He was still in the car, but I answered the phone because it was my dad calling. Trying to respond to him while cloaking my words in a way as to not upset my 6-year-old was hard. Living the last 10 years without my mom has been even harder.
I’ve written much about my sweet mama and how much I miss her. I’m not sure that there are new ways to say, I’m sad. I miss her. I feel lost sometimes. I worry that I don’t do enough to keep her memory alive. I can’t believe she’s gone. I don’t want to live the rest of my life without her. I’m afraid I don’t mother my kids as well as she mothered me. I’m totally pissed that she’s gone. I was robbed. She was robbed. It still hurts, a lot. It’s better, but it still hurts.
I miss her. So much.
I’ve been torn today, between wallowing in the sadness and doing the kinds of things she respected. Between feeling sorry for myself and being productive. Between having a shitty day and “walking on the sunny side of the street” (the latter was how she bid me farewell every day when I left for school when I was little). How can I walk on the sunny side of the street when the sunshine is gone?
Lately, much has been written about the rush-to-mastectomy decisions adopted by women with DCIS diagnoses. DCIS (ductal carcinoma in situ) is the diagnosis given when abnormal cells reside in the milk ducts. It is precancerous and noninvasive. It is not life-threatening, although it can lead to an increased risk of developing an invasive cancer. While it is unquestionably scary to receive such a diagnosis, some in the medical community are questioning whether a slash-and-burn reaction to DCIS is appropriate. The current standard of care for DCIS is surgery and radiation. A natural reaction for a woman with DCIS is to undergo the most far-reaching form of treatment available. I won’t argue with that, because no one has the right to judge another person’s reaction to or decisions toward a cancer diagnosis. Anyone who tries to should be punched in the brain. Repeatedly.
That said, data don’t lie, and the case being made for a less-aggressive approach to DCIS is gaining ground. Dr Laura Esserman, a breast surgeon at the University of California, San Francisco, is setting the pace. In a recent New York Times article, Esserman says her goal is “to move the field and do right by our patients.”
Instead of immediately ordering biopsies for women with unsettling findings on their mammograms, Dr Esserman recommends active surveillance. She favors the “wait and see” approach, speaking out about the myriad ways in which a woman is adversely affected by slash-and-burn treatment for cancers that rarely progress beyond DCIS.
Dr Esserman is bringing to light the fact that mammograms — while valuable — find the slow-growing, non-metastasizing cancers that lead to panic more than they find the most lethal forms of breast cancer. She is lobbying for big changes in the early-detection world and has asked the National Cancer Institute to consider dropping the word “carcinoma” from the DCIS label. Instead, Esserman would like for DCIS to be renamed “indolent lesions of epithelial origin.” IDLE would replace DCIS as the way to describe a stage 0 diagnosis. IDLE is catchy and much friendlier than DCIS, if you ask me.
This woman is turning the breast-cancer world on its head, and I like it. In an era of less face-time with doctors, Dr Esserman spends as much time as needed with each patient, often texting or calling them at home. A big part of her “wait and see” approach to DCIS is asking the patients soul-searching questions and utilizing specific testing to gather further evidence before recommending surgery. She’s pushing for more innovation in clinical trials and for fine-tuning the process of screening for breast cancer. In cases for which she does recommend surgery, Dr Esserman counsels and frets like a family member, and even sings to her patients as they undergo anesthesia. Personally, I’d much prefer a serenade to a prayer before I go under the knife. I can imagine her patients, smiling and relaxed, as they enter the last blissful sleep they will enjoy for a while to come.
I love Dr Esserman. I don’t know her, but I love her. I love that she’s crashing through long-standing views and taking the road less traveled. I believe she will enact great change in the landscape of breast cancer. I wonder how I would have reacted to my own breast cancer diagnosis if mine had lacked an invasive tumor. If my cancer was simply DCIS, would I have chosen a different path? I don’t know, but I do know how scary my diagnosis was. I know that the scorched-earth treatment plan was right for me. I had watched my mom die from cancer at age 67. My kids were still in grade school when “the C word” was applied to me. I wanted to be as aggressive as possible, so my choice was to go balls-out against cancer. And it’s a good thing I did, because my “non-affected” breast turned out to be riddled with cancer. Nothing showed up, though, on any of the screenings. Nothing. When Dr Esserman mentioned that mammograms don’t find the more lethal forms of breast cancer, I nodded my head knowingly and actively talked myself off the roof rather than allowing myself to think “what if?” What if I had chosen a single lumpectomy or single mastectomy, and that smattering of cancer cells and Paget disease in my “unaffected” breast had continued to evade detection? Would I be sitting here, typing this post? Would I be glancing up from my computer to see this guy outside my window? What if?
Remember seeing this photo in the aftermath of the terrorist attacks on the World Trade Center on September 11, 2001?
Marcy Borders, who came to be known as “the Dust Lady” survived the WTC attack after fleeing her office on the 81st floor of the North Tower. She was 28 years old. That terrible day set off a chain of events that ended tragically: on Monday, Marcy Borders died, at age 42, from stomach cancer.
Borders suspected a connection between the terrorist attacks and her cancer. In an online interview, she wondered if her experience on that terrible day caused her cancer: “I’m saying to myself, ‘Did this thing ignite cancer cells in me? I definitely believe it because I haven’t had any illnesses. I don’t have high blood pressure … high cholesterol, diabetes. … How do you go from being healthy to waking up the next day with cancer?”
That’s a question many of us have asked. Whether young or old, the question of how one goes from healthy to cancer-ridden remains, and that question can haunt those of us who have stared into the eyes of the beast that is cancer.
For those who were at Ground Zero, that haunting question becomes a common refrain. It’s hard to know just how many cancer diagnoses resulted from events surrounding the terrorist attacks, but we do know that first responders and civilians fleeing the towers were exposed to a nasty combination of carcinogens. This toxic dust is likely responsible for the fact that people present in the terrorist attacks have gotten certain cancers — skin and prostate cancers as well as non-Hodgkin’s lymphoma and mesothelioma — at significantly higher rates than people in the regular population. Even now, more than a decade later, the lingering health effects remain unknown, but experts suspect the full extent of cancer and 9/11 will begin to emerge, as it has with Marcy Borders.
Photographer Michael McAuliff was also at Ground Zero on September 11, covering the events for ABC News. He too wondered how his health was affected by the dust that covered Marcy Borders and everyone else in the vicinity. He collected and saved the dust that covered him as he worked on September 11, 2001, and recently submitted the dust and his computer bag he carried that day for testing. When the test results arrived, McAuliff discovered:
“About half the material was ‘non-fibrous’ including polystyrene foam, vermiculite mineral, combustion product (carbon soot), mineral dust of gypsum, calcite, dolomite and quartz. The other half was fibrous material including “cellulose (wood and paper fragments), fibrous glass such as glass wool with yellow resin coating, Fiberglass, colorless mineral wool, refractory ceramic fibers, limestone, calcites, carbon fibers, synthetics (including fragments of cloth) and chrysotile asbestos associated with the lime and carbonate insulation debris. Also found were ‘additional chemical signatures of silicates, kaolin clays, pigments (TiO2), calcites, dolomites, carbonates, metal complexes (sub-micron chromium, aluminum/iron matrices) and chrysotile asbestos.’ Metals included small amounts of lead, chromium, zinc and cadmium.”
McAuliff seems to have dodged a bullet and has received a clean bill of health. Unlike Marcy Borders.
Surviving the terrorist attack was just the beginning of a long battle for her. In an interview, Borders said “it was like my soul was knocked down with those towers.” Her battered soul endured depression and drug addiction. “My life spiraled out of control. I didn’t do a day’s work in nearly 10 years, and by 2011 I was a complete mess. Every time I saw an aircraft, I panicked. I started smoking crack cocaine, because I didn’t want to live.”
Ten years later, Borders decided she did indeed want to live, and in April 2011 she entered rehab. She worked hard to reclaim her life and move forward. She got sober and committed herself to putting that terror behind her, saying “The anniversary of (9/11) gives me no fear. I’ve got peace now. I’m not afraid of anything. I try to take myself from being a victim to being a survivor now. I don’t want to be a victim anymore.”
Rest in peace, Marcy Borders, and know that you are much more than “the Dust Lady.” You are proof that we can endure terrible things and come away with peace.
I’ve been in need of a reason to sit down at my computer and bang out a blog post, but I’ve been lazy. Chalk it up to summertime and its glorious release from the grind of our daily schedule. Thankfully, the blog challenge put forth by Nancy’s Point and taken up by Marie motivated me to shake off that laziness and get to it.
15 things. Random things about me. I know y’all have been itching to know more about the inner workings of my particular brand of crazy. Have at it.
1. I love animals and have been accused of loving critters more than people. To which I say, it depends on the person.
2. Meat in any form grosses me out, big time (correlation to fact #1?). I still cook chicken and turkey for my family but wear latex gloves to handle the raw stuff, and the process of picking out a package of meat at the grocery store usually makes me want to barf. Because we have a pet pig, pork is obviously a no-go in my house.
3. Being organized makes me happy; chaos makes me hyperventilate a little.
4. I have an addiction to lip balm. I have tubes of my favorite kind stashed everywhere: in the kitchen, in my car, on the patio….I leave the lids off so I can grab the tube, swipe it on, and keep moving.Every chance I get, I visit a different grocery or drug store to look for my favorite kind. When it seemed to be getting scarce, I ordered an embarrassing quantity online. When my favorite girl saw that stash she asked if I had robbed a Blistex salesman. Ha, ha, very funny.
5. I love books and am torn between relishing the heft of a real book and being seduced by the convenience of ebooks.
6. Patience is not one of my virtues. Being stuck in line drives me crazy, as does a pokey driver in the left lane or a string of people walking slowly.
7. Similarly, I struggle with diplomacy. I want to say the right thing, the kind thing, but the harsher, more direct version is what comes to mind first.
8. I would love to speak a second language. I took Spanish in high school, but my teacher was a childhood friend of my dad’s and I had yet to master the art of working hard despite the easy out. Or easy A, as the case may be.
9. Physical activity lights my fire. I love a grueling workout, a multi-hour tennis match, an afternoon digging in my yard.
10. I get a huge dose of satisfaction from being productive and am not so good at sitting still.
11. I’m a foodie and am usually thinking about lunch as I’m eating breakfast. I used to tease my sweet mama for doing that, and now I do it, too.
12. I didn’t like beer for more than 20 years, but being on long-term antibiotics after a nosocomial infection changed my taste buds. There are few things better than the first sip of an ice-cold beer.
13. While on the topic of booze, I should confess my undying love for champagne. It makes every occasion a special one.
14. I’m a germophobe. People coughing or sneezing in public makes me cringe, as does the idea of sharing a cup with someone else. People who share a toothbrush are like aliens to me. I cannot wrap my head around that concept. Eww.
15. I love lists and always have a to-do list going. Perhaps that’s why the idea of a post listing 15 things appealed to me.
The rain has been relentless in my part of the world. H-town has made national news this week, with photos of our soggy city and Mother Nature’s destruction relaying the misery.
Here’s a shot comparing the same freeway before and after our epic rainfall.
And another before-and-after shot in the Meyerland area (although the way the photographer arranged the photos, it’s an after-and-before shot).
This photo was taken Tuesday morning near the Museum District. MacGregor is the street we exit to go to the Houston Zoo. It’s crazy weird seeing such familiar sites under so much water. The state climatologist (yes, that is a real job) estimates that Texas has received more than 7.5 inches of rain in May.
We haven’t seen rain like this since Hurricane Ike, which hit my city in 2008. In fact, the Houston Weather Service has not issued a flash flood emergency since Ike. Until this week. We have had rain in biblical proportions. Some areas of Houston were drenched with 11 inches of rain Monday night and Tuesday morning. One of our local weather nerds equated that rainfall to 162 billions of gallons of water.
In the suburb I call home, the aftermath of the storm was less dramatic. Thankfully. Our house backs up to a bayou that has a small stream running through it; normally we can’t see the water out our back windows. This is what it looks like on a normal day (sometimes you can even catch a glimpse of sweet Pedey, sunbathing or napping).
It was hard to tell just how deep the water was, and I had a fleeting thought about crossing that little road to get a photo of the other side of the bayou. A very fleeting thought.Several steps in, the water was halfway up my boots.
A few more steps, and the water was coming in my boots.
My beloved bayou was flooded. I wondered what this meant for the wildlife we love to observe just beyond our back gate. No sooner did I wonder when I heard a splash and saw a young deer swimming across the bayou. I watched to make sure she got across safely and made a mental note to throw some kale and dried corn over the fence for her. The lush foliage and wild berries she normally nibbles on were washed out.
I just read Angelina Jolie Pitt’s op-ed in The New York Times about her second preventative surgery: to remove her fallopian tubes and ovaries. Just as she did with her prophylactic bilateral mastectomy two years ago, Jolie Pitt writes articulately and openly about her laparoscopic bilateral salpingo-oophorectomy, using imagery and opinions that those of us who have walked in her shoes immediately understand.
She writes, “The beautiful thing about such moments in life is that there is so much clarity. You know what you live for and what matters. It is polarizing, and it is peaceful.”
So much clarity. Amidst untold chaos and unimaginable confusion, there is clarity.
She recounts her consultation with the GYN surgeon, who had also treated her mother: “I last saw her [the surgeon] the day my mother passed away, and she teared up when she saw me: ‘You look just like her.’ I broke down. But we smiled at each other and agreed we were there to deal with any problem, so ‘let’s get on with it.’”
I had a similar encounter with someone who cared for my own sweet mama during her cancer treatment. The woman who was my mom’s radiation tech is now a nurse in my orthopedist’s office. I knew as soon as I saw her face that she was the kind practitioner who blasted pointed radiation into my mom’s beleaguered body five days a week for weeks on end. When I encountered her in the orthopedist’s office, I was thrown for a moment because she was out of context. But before long we realized who each other was, and she said the same thing to me that Jolie Pitt’s mom’s surgeon said to her: “You look just like her.”
Stupid fucking cancer.
When Jolie Pitt wrote about her mastectomy in May 2013 she cast the spotlight on the issue of femininity being defined by body parts. After her mastectomy she wrote: “I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.” With her latest surgery, Jolie Pitt casts the spotlight on another jarring and difficult result: forced menopause.
Becoming menopausal decades before its natural occurrence is unpleasant, to say the least. The physical and emotional ramifications of forced menopause suck. Really suck. There is no easing into the myriad effects, which can include hot flashes, night sweats, increased sweating, sleep disturbances, mood swings, urinary tract infections, sexual disfunction, memory loss, difficulty concentrating, back pain, joint stiffness, and fatigue. As if that’s not enough, throw in the accelerated aging: loss of elasticity in skin, lack of collagen, hair loss, brittle nails, diminished muscle tone, slower metabolism, and weight gain. Suck. At a time when many women are claiming the best version of themselves (“40 is the new 20!” “I’ve finally come into my own!” et al), early menopause creates instant grannies. Suck. If anyone can shed light on the ugly truths of forced menopause, my money is on Angelina. Yes, she has unlimited financial means and resources unavailable to the average cancerchick, but she also has a platform for educating the masses and she’s gonna use it. Hooray!
At the time of this publishing, there were 321 comments on her story; by the end of the day that number will have climbed. The handful of comments that I scanned were positive, but there are some who chastise her for her choices. I’m always amazed at how ugly people can be with the anonymity that our online world provides. How nice it would be if those cowardly, overly opinionated haters could really digest Jolie Pitt’s reasoning and respect her choice. How nice it would be if they would re-read the last sentence in this segment of her latest essay:
“I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this. A positive BRCA test does not mean a leap to surgery. I have spoken to many doctors, surgeons and naturopaths. There are other options. There is more than one way to deal with any health issue. The most important thing is to learn about the options and choose what is right for you personally.”
Choose what is right for you personally.
What works for you may not be the same thing that works for me, or for your neighbor or your cousin or the woman who works at your favorite Hallmark store. Cancer, like any disease, is an immensely personal issue, and any and all decisions resulting from a diagnosis should be personal.