Homework

Posted: January 7, 2011 | Author: | Filed under: breast cancer, drugs, infection | Tags: , , , , , , , , , , , , , , , , , , , , | 5 Comments

I’ve been reading up on and researching reconstruction. Oh, to return to the days in which the only context I had for reconstruction involved the South rising again.

Alas, that’s not to be, and the horse is out of the barn, the worms are out of the can, and we can’t unring that bell. So now reconstruction means something entirely different.

It was supposed to be a pretty simple affair: tissue expanders put in at the time of my mastectomy, which would be filled with saline slowly and gradually, over a period of a few months, to allow my skin to stretch and accommodate a set of perky but modest implants (male readers, go ahead and groan at the mention of modest implants.) Why does one need her skin stretched for implants, when millions of women get the orbs jammed into their chests in a single step? Because those millions of women haven’t had their flesh scooped out down to the ribs. (Hope you weren’t planning on eating BBQ anytime soon.)

Back to the implants: my simple affair turned in an epic fail when the right tissue expander exercised some really bad judgement in allowing a mycobacterium to share its space. Ah yes, the infection. That dadgum bug turned my world upside down, and fast-tracked me from post-surgery superstar to sick, sick, sick. My recovery was going so well. I was convinced I’d be back on the tennis court in a month. Sigh.

Moving along to option B: the TRAM flap. It’s a big surgery (8-12 hours average) with a week’s stay in the hospital and 3-to-6-month recovery. Youch. I didn’t really get how they accomplish this surgical feat, so in the course of my research I watched a youtube video of an actual TRAM flap procedure. “Ewww, gross” doesn’t even begin to cover it.

In laymen’s terms, the surgeon cuts a football-shaped piece from your tummy, with the incision going from hip to hip. He or she (for this purpose, we’ll say “he” since Dr S will be the surgeon, but y’all know I’m all about equal opportunity so I must digress) then cuts the rectus abdominal muscle, in its entirety or partially, and  uses that muscle as the blood supply (e.g., blood vessels and small arteries) in the newly created breasts. Then he tunnels his way from the tummy incision up to the breast area, shoving tummy fat upward to create the new breasts.

After recovering from the grossed-outed-ness of watching this, I marveled at the ingenuity of the technique. Pretty cool stuff. But I admit it unnerved me for a few days. You may recall from previous posts way back when this all started that I HATE hospitals. I detest the smell, the noise, the lack of privacy, the parade of people in & out of the room, the clanking of carts up & down the hall, the cafeteria-style food, the machines beeping, the cords snaking everywhere, and the omnipresence of needles and IVs. I do like the morphine, though.

In addition to my extreme and unconditional hatred of all things hospital, I now fear them greatly and mightily because of the infection. I’m really, really scared. Like “want yo mama scared.” The risk of infection in any surgical procedure is estimated to be 3 percent. That’s pretty low, right? When you think about all the different surgeries done in all the different hospitals in all the different cities every day, that’s pretty low. But leave it to me to be the one person who gets it. Sheesh.

And leave it to me to get a rare infection that is not only hard to classify but hard to kill. Hence the never-ending 12-hour cycle of oral antibiotics. A quick back-of-the-envelope calculation tells me I’ve been taking those two oral abx for about 140 days. And there’s no end in sight.

So you can see why I’m not exactly rushing back into the OR for my reconstruction.

However, the compelling reason to get in there and get ‘er done is the complications still arising from said infection. Dr Grimes, my infectious disease doc, thinks that undergoing the surgery sooner rather than later will help clear up some of those complications by way of cleaning out the unhealthy tissue and replacing it with fresh new tissue with a brand-new blood supply. Sort of like replacing your old, threadbare socks with a nice new pair.

That’s why I was doing my homework and scaring myself half to death, so that I can go into my appointment with Dr S armed with knowledge and ready to proceed. I took a lot of notes and tried to keep up with all the different kinds of flap procedures: pediculed vs non-pediculed vs perforated, etc. Then there are variations on the procedure called DIEP and SIEA flaps (Deep Inferior Epigastic Perforator and Superficial Inferior Epigastic Artery, respectively). Prior to my research, I had no idea what TRAM stood for but speculated, based on my limited knowledge, that it was “That’s Rough on your Abs, Ma’am.” Turns out it’s actually Transverse Rectus Abdominis Myocutaneius. Good to know.

I didn’t pay much attention to the DIEP and SIEA flaps, because the TRAM flap was the only procedure Dr S had ever mentioned. I assumed that’s what I’d be getting. We all know what happens when you assume…

Dr Dempsey pointed out, however, that the DIEP flap is the one for me because it spares the ab muscle, something I will want and need as I go forward in my long, active, tennis-filled life. The DIEP flap is a more complicated surgery (12-15 hours), though, and there’s not nearly as much info available on it as there is on the TRAM flap.

Here’s why: the DIEP involves a lot of microsurgery. Instead of transferring the ab muscle and its blood vessels to the breast area, Dr S will make that big incision on my tummy, but leave the muscle there, removing the blood vessels and arteries entirely and reconnecting them in the new breasts. Apparently he will have to cut a piece of a rib, too, to make this all come together. I choose to skip over that part and not even think about it. Yikes.

The DIEP is considered the gold standard of flaps. And the reason there’s not as much info available is that it is a more technically complicated surgery, and not many surgeons do it. But if you’ve read any of my posts about Dr S, you know that he is the gold standard of surgeons, so I’m in good hands.

Stay tuned.

Dear Santa,

Posted: December 22, 2010 | Author: | Filed under: breast cancer, cancer fatigue, drugs, food, infection, kids | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | 4 Comments

I’ve been a pretty good girl this year. I’ve smiled at fussy babies in checkout lines at HEB. I did my time at the grade-school class parties (not my scene, to say the least). I called the collection agency back — yes, I really did — when they left me a message saying I owed money on a past-due hospital bill that my insurance company says has been paid. I donated nearly-new clothes & home goods to charities multiple times. I helped out with the school fundraiser, even though I really, really, didn’t want to. I’ve said please and thank you and bring my own bags. I was a big girl and good sport about all the trips and baseball games I missed this past summer.

And while we’re on the topic of this past summer, dear Santa, do ya remember all the hell I went through? It all started on April 27, 2010, when I was diagnosed with breast cancer. Talk about an “aha” moment. The timeline quickly unfolded like this: the rest of April and first part of May were consumed with tests, tests, and more tests: BRAC analysis, CT scans, x-rays, PET scan, bone scans and MRI. In case that’s not enough acronyms for ya, there was also the L-Dex and then the genomic typing of ER/PR positive and HER2 negative. More injections and blood draws than my poor left arm’s veins could keep up with (literally; there’s a permanent knot in the big vein). Countless appointments with the breast surgeon (Dr Dempsey, who is on the “nice” list) and plastic surgeon (Dr S, who may be on the naughty list), and 3 different oncologists.

Meanwhile, there was research to be done and crushing decisions to be made as I prepared for surgery. The phrase “life and death” took on a whole new meaning, sweet Santa. There’s a strange juxtaposition between packing school lunches and signing field trip permission slips while also filling out my medical directive and living will. I learned pretty fast how to act normal when everything around me had been turned upside down. I think, dear Santa, I also did a pretty good job of adjusting and adapting to the new normal. I think, fat man, I’m still doing a damn fine job of that. One quick look at my profile tells you that there most definitely is a new normal around here.

Santa baby, I was a good girl after the double mastectomy and the lymph node removal that left me battle-scarred and weary. I was an especially good girl in the face of the plethora of prescription drugs I could have used & abused. I was a diligent girl when it came to choosing green drink over Diet Coke, all-natural hormone-free yogurt over Blue Bell.

Santa, I was a brave and good girl when the nasty infection set up shop in my still-raw chest wall. I endured the 103-degree fevers, 22 days in the hospital, multiple tissue excisions and untold poking & prodding without much complaint. I missed the comforts of home, my dogs & my kids more than words can say, but I only cried twice. And even then, it was when no one else was around to see.

We don’t even need to recount the 18 days during which I was attached to the wound vac 24-7. I would really like, dear Santa, to permanently erase that memory from my grey matter, por favor. But I would like to remind you that I was a trouper during the home health days, and all those hours that were consumed with wound care and the administration of IV antibiotics. And while I’m at it, can I get a little shout-out for not killing Dr S, even though he probably deserved it?

Oh Santa, I do crave some credit for all the antibiotics I’ve endured — and continue to endure. From the Vancomycin to Cefapim, from the Cipro to the Zyvox, from the Biaxin to the Bactrim and Minocycline. Those last two will be part of my daily routine for a few months yet, but I’m already looking forward to the day in which I don’t have them on my kitchen counter anymore.

So Santa, how about we make a deal? I’ll set out all the milk & cookies you want in exchange for one little thing. All I want for Christmas is to have it easy for awhile.

Now that’s some bank!

Posted: December 15, 2010 | Author: | Filed under: breast cancer | Tags: , , , , , , , , , , , , , , | 2 Comments

The photo isn’t great, for which I apologize, but hopefully it’s good enough for you to see the amount payable to the American Cancer Society: a whopping $93,545.00

Yowza. That’s quite a check. It’s from the Couture for the Cause, which you loyal readers will remember was the premier Fort Bend event at the end of September in which funds were raised for the fight against cancer, and in which yours truly participated in the fashion show.

You may recall the tremendous amount of trepidation I felt toward the event. If not, let me remind you: I really, really, really didn’t want to do it. I had only been out of the hospital a few weeks, and was not in runway shape, to say the least.

However, as with most things we force ourselves to do, in order to stretch our comfort zones or become a better person or whatever reason for the torture, it ended up being one of the absolute, bar-none, best-ever experiences of my entire life.

As much as I’d like to claim responsibility for that huge sum of money raised, the truth is that beyond the $100 ticket that Trevor bought to attend the event, I didn’t have a whole lot to do with it. But next year, I will. Because I will be hounding everyone I know to pony up, buy a ticket, and come to the event. I plan to do the fashion show again, and I expect you all to be there.

In reflecting back on how scared I was to do the show, and how uncomfortable I was in my outfits (but loved every inch of the shoes!), I’m grateful for a whole lot — for having the courage to do it even though I didn’t want to; for having parents who raised me to honor a commitment even though I didn’t want to; for being upright and out of the hospital, not attached to an IV or a wound vac; for the great and true friends who were there that night to cheer me on; and most importantly, for life and the ability to savor it.

Lenny, the director/producer of the event, sent an email the day after the shindig, to the volunteers and models. He wrote something pretty special, and I want to share it:

Please know what a personal and professional experience last evening was for Tamara, me and my fashion team. We love our work in the fashion industry. I am grateful that through the almost 60 – 70 events me and my team produce a year that we are able to help important causes raise awareness and more importantly dollars for worthwhile causes. But the true joy of our work is the people we meet and get to work with along the way. Tamara, me and my team spent all of last night after the show while packing things away recounting very special moments each of us experienced with each of you. We are grateful for those moments and they will mean much to us for a very long time. This event  honors and celebrates a special group of people who have experienced or are experiencing cancer. While there are many stories I will share one from last night. One of the models was very gun-shy about participating in this event. She came into the fitting at Tootsies tentative and not all certain about modeling in the show or that we would find anything flattering for her to wear. Her experience with cancer is fresh and current, recently having surgery. During the hair and make up prep period I started seeing how excited she was getting. She especially loved her hair. During the show I remember her beaming as I sent her to walk the plank. After the show she shared what an amazing and fun time she had by modeling in this show and said she would see us next year. And she will.

It’s just rice

Posted: November 6, 2010 | Author: | Filed under: breast cancer, drugs, infection | Tags: , , , , , , , , , | 2 Comments

Most people probably spend the extra hour we gain in Daylight Savings by sleeping. I usually use that extra hour to clean, as something around here always needs cleaning. This time, however, I’m going to spend the extra hour reflecting on my good health.

It’s a tenuous state. And after my little scare this week, I’m planning to savor it even more. In case you missed the update, I had some fluid on my right side that Dr S wanted to drain so he made yet another hole in my chest wall on Tuesday. All week the gunk that drained out of the latest hole was pretty nasty looking, and infection was on everyone’s mind.

Friday I saw the newest member of my infectious disease team, Dr Samo. I wanted him to see the gunk and tell me unequivocally that I had nothing to worry about. As much as I try to live by the “don’t borrow trouble” mantra (thank you very much, Amy Hoover), this gunk was worrisome.

As I drove into the Medical Center Friday morning, I was mentally reviewing the all-too-familiar list of things to pack for a hospital stay, just in case. I even wondered if I should pack a bag, since I had no idea what to expect from this doctor visit. Imagine my relief when Dr Samo was universally unimpressed with my gunk. I’m really glad. He said he agrees with Dr S, that we’re not looking at infection but simply some unhealthy tissue that’s not getting enough blood supply and dying a slow, gunky death. That kinda creeps me out, to think of decaying stuff on the inside, but compared to infection it’s positively lovely. Big sigh of relief.

There was some great comic relief in the waiting room of Dr Samo’s office. An elderly lady was waiting with her daughter, and both were pure country. They talked r-e-a-l slowly and with a heavy twang. No idea what they were there for, but they had a hilarious conversation that was too funny to not overhear. Mama said to daughter (very s-l-o-w-l-y), Next time you go to the store, I want you to bring home an orange. After a very long pause, daughter asked why, and mama said, to eat of course. Daughter chose to dredge up some ancient history by mentioning the apples she brought home from the store that mama never ate. Mama knew she was busted, and deftly changed the subject to someone named Timothy, who apparently isn’t much into fruits & vegetables, but according to mama, eats more than you think. She went on to say that when you think about it, Timothy eats salad (r-e-a-l g-o-o-d), and will eat peas, corn, potatoes, baked beans and rice. Daughter let the baked beans go, but pointed out that rice isn’t a fruit or vegetable. Mama said, well sure it is; if not a fruit or a veg, what is it? Daughter said, It’s just rice.

So there you have it folks, at the end of the day, it’s just rice.

Oh no, not again!

Posted: October 19, 2010 | Author: | Filed under: breast cancer, cancer fatigue, infection, tennis | Tags: , , , , , , , , , , , , , | 2 Comments

So I have this little spot on the area formerly known as my right breast, which is now known as the right chest wall and was, over the summer, the site of a whole lot of activity. Things have been really calm lately, so I guess it was time for something to happen. This little spot popped up a week or so ago, about the time I started playing tennis again. Because I so enjoyed being back out on the court, and because I really needed to believe that I was finally out of the woods, I tried to ignore it. It wasn’t very big, it wasn’t all that red, and it only stuck out a little.

Well, if I’ve learned one thing from this whole mess, it’s that ignoring a spot in the hot zone doesn’t work. Never. No matter how hard you try. So once this little spot got a little bigger, a little redder, and stuck out a little more, I knew it was time to make the call.

I’ve gotten to know Dr S’s office manager, Marcie, and his nurse, Brenda, really well. Maybe too well. So when Marcie answered and I told her what was going on and I asked her if she wanted to ask him if he needed to see me, she said she wasn’t going to ask because we both know the answer. And yes, she does just lay it out there like that. Personally, I find it refreshing.

My  next check-up with the good doctor isn’t for another 3 weeks, and Marcie said there’s no way he’s going to wait that long to see you, so get yourself on in here. I tend to do what Marcie says. Dr S, not so much, but Marcie for sure.

When Brenda saw the little spot, she made that face. That “I skipped the poker face” lesson in nursing school. That face that makes me want to run screaming out of that building and never come back. So not only did she make the face, but she said he’s probably going to want to biopsy that. Commence running and screaming.

He wasn’t in that exam room five seconds before he hollered at Brenda to get him a syringe and a needle. I said, Wait — a syringe and a needle? Why both? What are you going to do? He looked me right in the eye and said, I don’t know, but I need a needle! A this point, it was too late to run screaming from the building, but I wanted to.

He poked the spot with the needle– more than once — and then used the syringe to try and collect something but nothing came out. The spot appears to be nice and harmless. Perfectly innocent. It’s probably scar tissue, so we’re just going to watch it. Keep an eye on it. See what happens.

Works for me. I’m thinking I’ll be out of there in time to get the cheap rate on the parking. Just wanted to ask him one question though, real quick as he’s out the door.

All I wanted to know was the name of the doctor in Miami who pioneered the technique that he’s thinking of using for my reconstruction. I’ve done a little research, but not much, and wanted to make sure I was headed in the right direction.

I have a lot of questions about this procedure, and it’s a big decision to make now that it’s not as simple as tissue expanders to implants. But I wasn’t going to ask the questions right then, because that’s a conversation for another time. I just wanted to know if I was on the right track in my fact-finding.

If you missed my post on Caring Bridge a while back about the “examine the fat” game I played with Dr S not once but twice, for two times the humiliation, you’re in luck because I’ll be dadgummed if he didn’t want to play it again. And as we all know, whatever Dr S wants, Dr S gets.

(If you want to read the original post, go to http://www.caringbridge.org/visit/nancyhicks/journal/2. I haven’t figured out how to add a link to this blog so if that doesn’t work, go to the old Caring Bridge blog and look at the journal entry for October 6th).

Why that man insists of tormenting me, I will never know. But I think he really enjoys it. Just as I’m wrapping my head around yet another change in the game plan, from TRAM-flap reconstruction to this new Brava technique of building new boobs out of fat that’s been relocated, he throws me another curve ball. Now he’s thinking that maybe the Brava technique isn’t the right option for me after all. Maybe we need to re-visit the TRAM-flap, which means he needs to pinch an inch and see how much building material I have.

I said uh-uh, no way, not again. We have done this twice and I’m still recovering from the humiliation. I’m not doing it again. He didn’t go so far as to say he doesn’t remember, but that’s my suspicion. I guess I should be flattered that my fat is so unremarkable as to render him striken with amnesia not once but twice, but I’m too wrapped up in being humiliated, again.

That man doesn’t take “no” for an answer. I said it repeatedly, and y’all know I’m no weenie when it comes to making myself heard. I told him politely then with some choice words that I wasn’t going to show him again. His response: Come on, it’s not like I’m a stranger.

THAT’S THE PROBLEM! Once you lose the “stranger” status with your doctor,  you move from clinical to personal, in a hurry. I know this man too well and have quite frankly been through enough already and really shouldn’t have to suffer yet another indignity.

However, knowing him as well as I do and having been through as much as I have with him, I know the fastest way to get through the unpleasantness is to just, well, get through the unpleasantness. And that’s how I found myself once again playing the “examine the fat” with Dr S.

And guess what? The result was exactly the same: He scrutinized my belly and said there’s probably enough to make a B-cup. But only on one side. I said, I know you think I’m really demanding, but I insist on having a matched set. We had previously discussed the idea of doing the TRAM-flap for one side, and using an implant on the other side, but I said then and said again that I don’t want to do that. Just seems like asking to be lopsided at some point down the road. He actually agreed with me, which scared me just a little.

So he seems to be leaning toward the TRAM-flap again, and away from the Brava technique. He gave me the website to research, I said, ok fine, we’ll talk about it later. And I thought I was out of there.

As I was checking out with Marcie, though, he called me into his office. It’s not quite like it was being called to the principal’s office as a kid, but a little disconcerting still. He’d pulled up the website and wanted to go over it right then & there. I didn’t even want to think about how many patients were waiting for him.

So we looked at a bunch of photos and I was quite underwhelmed with the results. Maybe it’s because I was perfectly satisfied with the set-up I had, pre-mastectomy. I’ve explained that to Dr S before: that while he does amazing work, and the majority of reconstruction patients whose photos I’ve seen look way better after than they did before, I was just fine where I was. So the “new boobs” as a prize for going through breast cancer, mastectomy and reconstruction isn’t a big draw for me. Excuse me for being underwhelmed.

As if I’m not confused enough at this point, he introduces yet another option: taking the muscle from my back, under the shoulder blades, and using that to build the new pair of goods. We looked at some photos of that, too, but I had one question: how would that affect my serve? Seems to me that slicing the muscle away from an area that is used to torque the body and generate force while serving the ball means bad things for one’s game.  I’m not going through life with a permanently wimpy serve. I’ve suffered enough.

A word about menopause

Posted: October 11, 2010 | Author: | Filed under: menopause | Tags: , , , , , , , , , , , , , , , , | 10 Comments

If you’re a guy, you might not want to read this because it’s, well, about menopause. If you’re a gal who’s not yet experienced the joys of menopause, you might not want to read this because it will scare you. A lot. If you’re brave enough to venture forth, don’t say I didn’t warn you.

Because my cancer was fed by estrogen, after we got rid of the cancer we also had to remove its fuel source, to discourage it from coming back. Hence the stoppage of estrogen. The most direct way to stop the estrogen is to remove one’s ovaries in a lovely procedure called oovectomy (which would also be a seriously high-scoring Scrabble word). If you’re still fighting a wily infection, like me, being cut open in a hospital of all places is a pretty risky move. Especially since the hospital seems the most likely culprit in the age-old question of “How the Hell Do You Even Get an Infection Like That?” While it’s unlikely that my infection would travel from the chest wall to the nether-regions,  that’s a chance I don’t want to take, and frankly the idea of another hospital stay gives me the vapors.

Since I’m not ready for the oovectomy, I get the next-best option of hormone suppression, which is a shot of Lupron every 3 months, and a daily dose of Tamoxifen, which is a SERM (selective estrogen receptor modulator) drug. The latter half of that acronym makes me think of  something coming out of the Johnson Space Center instead of a prescription bottle from Walgreens, and talk about some great Scrabble words. Build one of those on a triple word spot and you’re damn close to world domination.

So I’m going along in my cancer journey, minding my own business, doing all the things I’m supposed to do, no matter how unpleasant, and yes it’s really good news that the cancer is gone and the infection is on its last legs, too, but do I really have to deal with menopause, too? That just seems mean. You’re seriously going to tell me that battling both cancer and a nasty infection doesn’t exempt one from the hell of menopause? Mean.

I foolishly thought I’d have another decade before having to face the evil triumvirate of menopause: hot flashes, age spots, and weight gain.  Even more foolish was the idea that, compared to cancer, menopause would be easy. Silly me.

Living in Houston, land of eternal summer, during hot-flash season, is a challenge. Come to think of it, neither Houston nor hot flashes have a season, so it’s game on, all the time. Local ladies, if you have any remedies for this please pass them on. I have yet to come across a mobile AC unit. I’d be waiting on the doorstep of Radio Shack to purchase said item and would wear it proudly, if only it existed.

So as I’m mopping my sweaty brow after one particularly potent hot flash, I notice some brown spots on my face. Little specs, bigger than freckles but not as big as liver spots. I tried to pick one off, wipe it away, flick it somewhere, anywhere, to no avail. These babies are staying. There’s a constellation near my left eye, and a nice fat one on the inside corner of my right eye. There’s a trio on my forehead, a few singles lingering on my jawline, and God knows where else that I’ve been too busy fighing cancer to really notice up close. Thank you to all my friends for not pointing them out to me. I know you’ve noticed, but were too charitable to tell me I was growing a connect-the-dot game on my face. And there’s a travel version of this game growing on my hands. I’m aging quite visibly as we speak. Thanks, cancer. You bastard.

While the hot flashes are unpleasant and age spots are depressing, the weight gain is really making me mad. I hope there is a special corner of Hell for whoever came up with the hair-brained idea that women will not only lose their breasts but also face scary treatments, complications and all manner of pain & suffering and then gain weight too? That is one messed up system.

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