Now that I have a surgery date…

Now that I have a surgery date, if you feel compelled to join the Greek chorus that’s asking if I really want to have the surgery, don’t.

Just don’t.  

I don’t want to hear it.

I don’t need to hear it. 

Isn’t the fact that I have a surgery date evidence enough of my decision to go forward?

If I didn’t want to have the surgery, would I really have a date? Would I be putting myself through the mental anguish that accompanies such a decision and the days that stretch on between said date and today?

Sometimes I hate people. 

Mainly those who say stupid things, but Sarah Palin & “President” Mubarak are on my list too. If you like either of these idiots, you may want to unsubscribe from this blog, because I will most likely rip on them and their idiot-ness a lot, esp when I’m in a foul mood like I am now. And if ripping on dumbasses makes me feel better, then Katy bar the door because I’m gonna do it. 

So there.

And don’t tell me that people mean well, and sometimes they just don’t know what to say. They can suck it. If it’s that hard to come up with something not stupid to say, then perhaps they should zip it.

But back to the surgery. Reconstruction is a big step. It’s a scary step. It’s a horrifying assault on my already-beleaguered body. If things were different, I wouldn’t be in a hurry to do it. By “things” and “different” I mean the path of destruction left by the blasted mycobacterium.

I hate that myco almost as much as I hate Sarah Palin. Sheesh, just typing her name makes me mad.

Ok, reigning it in.

That darn mycobacterium wrecked things up good. If it was just a question of having a flat chest, I’d be in no hurry for reconstruction. I kinda like my flat chest. It’s simple. It’s low-maintenance. I never have to wonder if people are paying attention to what I’m saying, because they’re certainly not distracted by cleavage (there is none). But thanks to the infection and subsequent tissue excision (gross, I know), it’s a mess that’s gotta be fixed.

And thanks to the infection, I can’t just pop in the implants and go along my merry way. I remember being asked as a kid if I had to do everything the hard way (I was a little stubborn back then). The answer is yes. Yes, I do.

I do not like surgery. Or hospitals. Or hospital gowns. Or hospital linens (scratchy, so scratchy). Or hospital food. Or the hospital smell. Or needles. Or being an invalid. Or depending on other people. Or waiting on other people to show up and do what they need to do so I can get outta there.

I do like the drugs, though.

But not enough to rush into a big, long, complicated surgery. So while I don’t actually want to have this surgery, I need to, to clean up the leftover infection mess. It’s going to be hard, and the recovery will be long. I won’t see a tennis court for several months. I will once again be at the mercy of other people’s kindness. But I need to do it, so I will. And I will leave you with another mantra from my childhood: If you can’t say anything nice, don’t say anything at all. Thank you, Thumper. Preach it, little rabbit. 

And if you can’t follow Thumper’s advice, and still feel compelled to tell me how dangerous this surgery is, or how complicated, or ask me to think about how it might affect my kids, or any other stupid thing that flies out of people’s mouths, then consider this: 


Official diagnosis

While looking through my paperwork from Dr Spiegel and mapping out the next month of pre-op stuff I have to do, I found something that made me laugh out loud.

I hope you find it funny, too.

If you don’t, there’s something really wrong with you.

This is the orders for the EKG and labwork I have to get done before my reconstruction. 

The handwriting is kinda hard to read, and the picture is pretty fuzzy, but if you look closely you’ll see that for Diagnosis, it says “absence of breasts.”

Other than laughing hysterically, I don’t know how to respond to that.


Introducing the New Dr S

There’s a new Dr S in my life. I’m happy to introduce Dr Aldona Spiegel. 

She’s purty.

And smart.

She’s younger than me and has 3 kids, ages 6, 2 and an infant. She’s tall, slender and blonde. And she’s a renowned surgeon. If I didn’t like her so much, I might hate her a little.

But she’s gonna build my new boobs, so I love her.

We had a fantastic consultation today. Every aspect of her office, from the atmosphere to the staff, is first-rate. Beautiful waiting area, pleasant receptionist, warm & friendly nurses, a big Mac (computer, not burger) in the exam rooms, a fantastic physician’s assistant, a comprehensive bound photo book of before & after pictures of her patients, and of course the lovely doctor herself.

According to her website, “Her goal is to provide not only the most advanced breast restoration procedures, but also a caring and supportive environment—allowing each woman to complete a successful rehabilitation from her breast cancer battle.”

I like that. I’m especially intrigued by the idea of rehab from my battle. Sounds good.

How about this: “Dr. Spiegel is committed to providing superior, patient-focused care and preparing the next generation of surgeons to meet the highest standards of excellence. This vision combines a dedication to advanced research, exceptional education, and the development of new, less invasive treatments and procedures.”

Great!

She trained in general surgery at Johns Hopkins Hospital and did her fellowship in reconstructive microsurgery and specialization in plastic surgery at Baylor College of Medicine where she was served as Assistant Professor of Plastic Surgery. Dr. Spiegel has trained with leading reconstructive surgeons around the world, developing and improving upon techniques to help minimize the aftereffects of breast cancer on a woman’s body.

This just keeps getting better and better!

Here’s where we get into the medical mumbo-jumbo: “Dr. Spiegel’s clinical expertise is in advanced breast reconstruction techniques and microsurgery, particularly in the area of surgical reconstruction with reinnervated autologous muscle-preserving perforator flaps, including the DIEP Flap, SIEA Flap, SGAP Flap, TUG Flap, and the TAP flap. Dr. Spiegel also specializes in Lymphedema Procedures, advanced Implant and Latissmus reconstruction, and has pioneered Sensory Innervation procedures which have the ability to reestablish sensation to the breast resulting in the most complete form of breast restoration. In addition, she is interested in all aspects of aesthetic surgery and is committed to women’s health issues in plastic surgery.”

Sweet. She is the total package.

The only complaint I have is with the panties. 

They were made of paper. And small. Really small. I spent a few seconds staring at them before thinking, one size does not fit all.

Egads. Cue the humiliation. Again.

Luckily, I’ve been humiliated in a doctor’s office before, so I’m ready for it and ok with it. I slipped on my pretty blue paper panties and the matching blue paper gown and prepared to meet my new savior, Dr Spiegel. I’m so glad I’m past caring about meeting a beautiful and successful doctor while wearing the most unflattering paper garments ever.

She answered all my questions, most importantly the one about weight gain. I’m good, I’m fat enough and don’t need to gain any more.

Whew, that’s a relief. I was getting pretty tired of drinking beer & eating chips. Now that I’ve bulked up, I am free to return to my normal, healthy eating. She said she would prefer to have a bit more building material, but she can work with what I’ve got, so I don’t have to worry about applying for a new zip code for all the junk in my trunk.

Now that’s a relief.

She’s planning my reconstruction, and it’s going to be pretty great. I’m actually starting to envision an end to this long, bumpy road. As much as I detest the idea of another hospital stay and recovery, I’m looking forward to closing the book on this chapter of my life. It’s such a cliche, but it’s true. Reconstruction is a big, scary step. I totally understand why some women never do it. And if not for the infection and the mess it left behind, I wouldn’t be in any hurry to do it myself.

But the infection did leave a nasty mess, and it continues to wreak havoc, and the best way to end that madness is to excise the tissue (again), and replace it with new tissue and a new blood supply.

It means a long surgery, a night in the ICU, and several additional nights in a regular room. Ugh, yuck, and ick. But, it will all be worth it when it’s done and I can say I’m truly on the other side of this wretched business.

Stay tuned.


A weighty issue

I received a serious assignment from my doc. Now don’t laugh when I tell you this, because it’s not funny, and don’t say “lucky you” because I’m not so lucky. It’s serious.

He wants me to gain weight. A lot of it. So he can build my new boobs. 

We’ve had this conversation a couple of times and I’ve stuck my fingers in my ears and said “la la la, I can’t hear you” because I didn’t want to do this. I’ve spent most of my life beyond the age of about 15 trying not to gain weight. When you’re five-foot-nothing, there aren’t a lot of places to hide the extra pounds, and I personally don’t like the way my body feels with a lot of extra weight on my frame. I’ve never been a skinny chick and don’t aspire to be, but don’t want to be mistaken for a contestant on The Biggest Loser, either.

I worked hard to prep my body before and after my mastectomy, to gain as much muscle strength and cardio conditioning while fueling myself with a good diet. I also played as much tennis as humanly possible in the weeks leading up to surgery. It all paid off, too, with a shorter surgery, no need for Alloderm (cadaver tissue used to connect and close mastectomied chests), and a pretty easy recovery. Because I was in good shape, I was up and out of the hospital bed the day after surgery, trolling the halls. When I got home, I had a decent amount of independence because I didn’t need much physical assistance. That was, and is, important to me. So the idea of turning into a big blobby girl, even temporarily, scares me.

The first few times Dr S brought it up, he warned me that I didn’t have enough belly fat to build the new girls. At that point, reconstruction seemed so far away that I didn’t pay much attention. But the last 2 times I’ve seen him, he’s been more stern about it. I hate it when he gets stern with me.

When I saw him a couple of weeks before Christmas, I told him I’d been drinking a few beers for the first time in 15 years, and I wasn’t playing much tennis because of a recurring foot injury. That was about as much as I was willing to commit to his “living large” plan. I did the usual indulging over the holidays, but I also went to the gym.

So when I saw him the other day, instead of shrinking from his “examine the fat” game as I have in the past, I told him I’d been working on a big project — a BIG project — and showed him my newly rounded belly. I was sitting on the exam table so my belly even hung over a little bit. I thought it was quite impressive, as it’s the biggest it’s ever been without a fetus inside of it.

He was not impressed. Not even a little bit.

He told me to pull my jeans down a little and gave me the pinch test, then had me bend over to see how far it hangs. So much fun. I live for that game.

Then he made a very stern face and said it’s not enough. It’s still not enough. It’s enough for one side, but not both. And maybe not even enough for one. Since I have impossibly high standards and insist on a matched set, that’s a problem.

Dr Sternface says I’m not really even a candidate for the DIEP flap procedure, but since I have no other options, we have to try and make it work. I was thinking about this later and wondered, if I’m not a candidate but don’t have any other choices (i.e., tissue expanders to implants), what’s a girl to do?

Eat, girl, eat. And then eat some more. Then have a beer. Followed by a milkshake.

People make fun of me for being a healthy eater. I genuinely like oatmeal with blueberries. I love salad. Not being a carnivore eliminates a lot of the unhealthier options for me, and I like it that way. I’m not super picky but I don’t like drive-through food in general, and I don’t get the “all you can eat” places at all. I’m not a big junk-food junkie, and usually whatever I cook is way better than that stuff anyway. Not being conceited, just stating a fact.

I’m not doing a very good job with my assignment. Yesterday I had half a bagel with a piece of melted provolone and a handful of blueberries. It felt pretty indulgent to me. Lunch was two pieces of leftover pizza, with an orange. Cheese & crackers for a snack before we played tennis, then dinner after with the tennis gang at a BBQ place. I had pinto beans with pickles, coleslaw, green beans, some mac & cheese and a few fries. Oh, and a roll. Wish I’d thought to put butter on it. Melanie told me that I wasn’t going to get the job done eating all those vegetables and suggested I get a milkshake. Every day.

Today we played 3 sets of tennis and I was hungry. We splurged on brunch at the club, which for me meant mixed fruit, cheese & crackers, salad with lots of blue cheese dressing, and some tuna. Mimosas, of course. Then some pasta with artichoke hearts, mushrooms & sundried tomatoes. Then a few bites of seafood ettouffee. And a sliver of key lime pie and a chocolate-dipped strawberry.

I feel kinda sick.

My doc keeps saying he just hates the idea of me going through this giant surgery and hard recovery and not being satisfied with the results. I keep telling him that any change over the status quo will be an improvement, and I’m ok being average. At least in this one category. He doesn’t seem to believe me, even though we’ve had the same conversation repeatedly.

He wants me to go see the other surgeon who will help him with my case. I’ll have to see what she thinks about the bulk-up plan. Meanwhile, I need to think of a new t-shirt slogan. Something like the “baby” with an arrow pointing at the pregnant belly t-shirt, only a different kind of “under construction.” Any ideas?


Homework

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.


Hunan Plastic Surgery

I read an article about plastic surgery in China (you may have, too, and if so, were you as freaked out as I was?). It told the story of Wang Baobao, age 28, who has had some 180 plastic surgeries. She started with her first operation at age 16, and has 6 or 7 procedures each time she goes under.

She’s had something done to “nearly every part” of her body: she’s had her eyes widened (and more Western-looking), her nose & jaw narrowed, and her chin reshaped. She’s had fat sucked out from her hips, thighs, stomach, and rear end. She even had heel implants, to make her taller (didn’t work). She’s had her breasts done, of course, and she says, “I had to keep having operations to repair them.” Yeah, me too.

China is third in the world of most plastic surgeries performed, behind Brazil and the U.S. No data, though, on how many procedures in any of those countries are for non-cosmetic problems.

The “official” estimate is that 3 million plastic surgeries were performed in China last year. The Deputy Secretary of the Chinese Association of Plastics & Aesthetics says his hospital sees 100,000 plastic surgery patients a year, and that all of Shanghai could see 300,000 a year. Try getting a hospital room there.

However, the Deputy Secretary points out that “most people don’t have surgeries at officially regulated hospitals. Many patients go to beauty salons and other unregulated facilities.” A beauty salon??? Egads. That’s a major infection waiting to happen. Trust me, I know.

Before the economic reforms of the 1980s, people in China were only allowed to have plastic surgery to correct a physical deformity, mostly  hairlip patients. Cosmetic procedures were considered a bourgeois way of life. What’s so bad about the bourgeois? Doesn’t everyone deserve a perfect physique? (says the girl with the flattest and most scarred chest in the Western Hemisphere.) I’m all for economic reforms, and think in general prosperity is a good thing for society, but when the rising tide of affluence is outpaced by the pursuit of physical beauty, we may be headed for trouble. Xi Shirong, the senior plastic surgeon at Beijing Hospital, says he sees at least 20 patients a day, mostly women in their 20s. That’s right, in their 20s.

24-year-old Wang Bei, a singer in China, died in the OR during a facelift. Can someone explain to me why a 24-year-old would need a facelift?

Back to Wang Baobao. She says the technology wasn’t good enough and the surgeons not skilled enough. One might think she’d be able to find a better surgeon, though, considering how many times she went under the knife. Isn’t that the definition of insanity: doing the same thing over & over but expecting different results? She says she kept “needing repair operations.” Again, me too.  Sigh.  She’s spent some $600,000 on her surgeries and says “the effects are not that good. And all over my body, there are too many scars.” Ya think?


Good ol’ Dr S

It’s been too long since I’ve posted a good story about Dr S, my most-favorite and much-abused plastic surgeon who saw me through the worst of the infection(s) this past summer and with whom I have an ongoing love-hate relationship. I love to needle him, and he hates to see my name on his clinic schedule!

I saw him Friday for a check-up (I love the way “check-up” sounds so simple & innocent, and misleadingly free of scary stuff like tumors and fat necrosis and scar tissue and reconstruction). He’s usually pretty prompt, and out of the many, many office visits I’ve had with him, I really haven’t had to wait too long for him. The few times it has happened, though, it has made me mad and I let him know it. I understand that delays happen, and the doctor isn’t always in control of the schedule, but I’m just an impatient person and it annoys me. My bad.

Friday was no exception. After waiting nearly an hour in the waiting area (so aptly named, that place), I waited some more in the exam room. I’ve explained before that although I am “just” an at-home mom, my time is still valuable, and I prefer him to keep some other patient waiting and get to me first. Not that I want some other patient to have to wait longer than me, but really once you’ve been diagnosed and gone through a nasty surgery and then the whole infection scene and multiple hospitalizations, well, ok maybe I do want someone else to have to wait longer. Surely all of that mess garners some sort of street cred or extra credit or something that allows me to go to the front of the line. But no. Like so many things related to cancer and subsequent recovery, there’s no easy way, no priority boarding, no free ride.

So after an hour of waiting on Friday, Amy and I were joking, as we’ve done before, about the many ways we could get his attention. We can usually hear his voice through the exam room walls and can gauge if he’s wrapping things up with the previous patient (although sadly, we can’t make out all the words and so can’t really get a sense of what they’re discussing, and y’all know how nosey I am; being able to properly eavesdrop would pass the time quite nicely). We’ve considered texting him from the waiting area and the exam room (yes, I do have his cell number), or knocking on the walls and hollering, Hurry it up in there, we’ve got to get back to Sugar Land for carpool!

Well on Friday we hatched a new plan and decided to write him a note and slip it under the door. We ripped the paper covering from the exam table and scribbled, You’ve got 5 minutes. Then we stuck it under the door.

Ballsy? Perhaps. Rude? A little. Effective? Most definitely. He burst through the exam room door post haste, note in hand and grinning wildly. He needed a little shake-up to his day. He muttered something about how he’s never in all his years had a patient give him so much grief. I replied that I’ve never in all my years liked waiting, something I’ve been imminently clear about from day one with him. Y’all may recall from my previous blog on Caring Bridge that I told Dr S at our first consultation, shortly after my diagnosis, that I know full well and good that he has other patients; I’m not his only patient, but I expect to be his number-one priority. I was kidding then, but oh how eerily prescient that little wisecrack turned out to be. Six months later–and today is exactly six months since my mastectomy–that man is still not rid of me.

Here’s the really funny part, though — he actually tried to blame his lack of punctuality on Daylight Savings. He said his schedule has been messed up since the time change, and I guess what we’re supposed to infer from that is that it’s not his fault. Time change, huh? It must have been pretty clear by the look on my face that I wasn’t buying that, because he asked me why I was looking at him as if he were FOC. I wasn’t familiar with that acronym so he said what about FOS? That one I know, and told him that I did indeed think he was FOS. Totally FOS. Since we “fall back” with the time change, he should have been an hour early!


Oh no, not again!

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.