WEDNESDAY MAY 30, 2007

To all Camille's circle, I am posting this for her. The surgery went well. In her own words, she is "UNDER CONSTRUCTION". She has received initially great news about the biopsy during surgery. She has a great sense of humor and is looking forward to moving on with the recovery.
Thanks to everyone for all the good thoughts
Joan Coke

Screw Cancer!

And screw my good eating habits too ... for today anyways. I had a big, fat, chunky hamburger with cheese, greasy french fries, and a Coca-Cola that burned the back of my throat for lunch! Mmm, mmm, good!!!

Tomorrow is my surgery. I have been very emotional today ... so I ate emotionally too. It was worth it ... to me.

I've been holding up rather well since my lumpectomy was scrapped at the last minute. I had a very enjoyable Memorial Day weekend with some friends who stayed with me ... we even did a spa day at the Ritz Carlton. A little on the pricey side (even with a friend's discount), but the champagne flowed generously so I didn't complain ... and this time I wasn't so buzzed that I mistakingly washed my hands with the green mouth wash (like I did the last time I was there). I did, however, forget to turn in the locker key. Oh, well ... who needs locker #32 in view of the other 250 lockers available at the Ritz Carlton anyway?

Last night, after my friends left me at home alone, I realized what I'm really going to be doing tomorrow ... and how different I will actually look and feel. Gosh, this sucks. I had to go to Target last night, minutes before they closed (yes, denial), to buy some pajamas that button down in the front since getting my arms into pullover nightwear may be challenging. I cried driving home and I've been pretty teary eyed all day today at work too. I don't even know why I came to work ... what a waste. I didn't do much today but read countless posts found on my online support group regarding recon and tissue expanders.

I am afraid of the impending pain ... I've been trying to gauge what to expect by what other people say. All I know is everyone tolerates pain differently ... so I know as much as I did before I even asked. I've probably made my pre-surgery jitters worse. I feel like I need a valium before I even get started tomorrow, but I have all kinds of restrictions on meds and food for the next 24 hours. Nothing to eat after midnight tonight. That means I have approximately 5 hours left to wolf down a big slice of carrot cake! I'm talking like this is the last supper before I'm sent to the electric chair, huh? Well, that's the same kind of anxiety I'm having ... I would imagine.

Thoughts and prayers are much appreciated right now ... and much needed. Please pray I don't have a massive coronary before my mastectomy. I certainly don't need any further delays. [Forced smile inserted here.]

My latest discovery ...

... I have no nose hairs. No wonder my nose keeps running. Just thought I'd share.

(I should mention, however, that I have 11 eyelashes and 6 eyebrow hairs that are still hanging on.)

Wednesday, May 30th is the new date

T-minus seven days ... and counting.

My bilateral mastectomy is now scheduled for next Wednesday, May 30th at 8:30 a.m. at South Miami Hospital. I seem to be in decent spirits ... maybe it's part denial for now ... but I am just seriously ready to do what I have to do. Not looking forward to the recovery period and all the in-between stages of reconstruction, but I AM looking forward to a healthy future and being on the other side of this whole thing with nice, new perky boobs! ( . ) ( . )

Plastic Surgeon Update

I called my surgeon, Dr. DerHagopian, last night and voiced my concerns about the consult I had yesterday with the first plastic surgeon he recommended to me. Because I have so much faith in and respect for Dr. D., I asked him why he felt so confident in this particular PS's abilities. He explained that he knew yesterday was such an emotional day for me, he wanted to be sure I had a chance to meet with at least ONE plastic surgeon the same day. And because that PS was located right downstairs in the hospital and because Dr. D. works with him all the time and feels he is very experienced with 25 years in practice, he was comfortable pushing to have him see me right on the spot. Of course, Dr. D. was completely understanding of my feelings and said he was happy to recommend other plastic surgeons until I felt most comfortable.

To be fair, I was in a bit of shock yesterday when I met with this particular PS and I may have perceived certain things he said as being somewhat negative. (Dad and Joan were there during part of this consult as well and seem to think they heard what he said a little differently.) Perhaps he was merely trying to "manage" my expectations and keep me a bit realistic about reconstruction following mastectomy, but I know I should still be able to have high expectations because I have seen quite a few pictures of truly wonderful looking breasts after a mastectomy.

I had called my friend, Price, as soon as I got home from that consult because he was instrumental in leading me to my surgical oncologist, Dr. DerHagopian ... and I hoped that I could now land a good lead to a reputable plastic surgeon. Price's colleague and friend, Dr. Jaime Sepulveda, had said at one time he wouldn't have anyone besides Dr. DerHagopian work on his wife if she were in a similar position. So when Price told me Dr. Sepulveda was now recommending Dr. Deirdre Marshall as an EXCELLENT plastic surgeon, I was almost certain she would be the right doctor for me. It was only an added plus when Dr. D. recommended her as well! (My oncologist also approves ... in an e-mail this afternoon she told me I will have an excellent surgical team in these 2 doctors.)

I had a great meeting this morning with Dr. Deirdre Marshall ... in fact, she called me around 9:00 pm last night after Dr. D. had called her at home to schedule a consult. Although she had 2 surgeries scheduled for today (and doesn't normally have office hours on Friday), she was willing to fit me in between her cases. She was so great when I met her today. She answered the whole litany of questions I had thoroughly, she was patient with her time (notwithstanding another surgery she had to perform), and she showed me a multitude of photographs of her work. Dr. Marshall has been in practice for 15 years since residency and she seems to be worth her weight in gold! (Oh, she is also in my insurance network and has her privileges at one of the same hospitals as Dr. D.) She assured me I will have beautiful breasts when everything is said and done. She showed me how she will mark my body for the incisions (that Dr. D. will then make) and that they will eventually be camouflaged nicely by tatooed areolas and new nipples that come after I have had the exchange surgery for implants! (I know this is probably too much information ... but I find what they are able to do to replicate real breasts completely fascinating. Boy, did I miss my calling in medicine!)

I know it seems surprising to many people that I am opting for a bi-lateral or double mastectomy even though I only have one affected breast. My decision has been greatly influenced by the experiences that have been shared by so many members of my online support group. The good majority of women who had to have a mastectomy and chose only to do one side at the time almost ALWAYS regretted not having done a prophylactic mastectomy on their good breast at the same time. Most of the time, they were in so much shock from the initial diagnosis that they couldn't process removing the other. And in almost all cases, these women went on to have a subsequent surgery to ultimately achieve symmetry in their breasts. I suppose because I've had 8 months to live with my diagnosis and process things, this decision is made a little easier. I have also had time to review soooooo many pictures of reconstructed breasts and hear experiences (good and bad) from my support group members that I was able to almost creatively visualize what I would do if it came down to me having to face a mastectomy. Most importantly, I should add that after all that I've been through already, I don't wish to ever go through this again or have any more anxiety about cancer recurring in the other breast. This is aggressive as it gets and I know it's the right thing to do now. If I have one breast or even two that are trying to kill me, they both have to go!

I will have what is called a skin-sparing mastectomy performed by Dr. D. ... this means all the breast tissue will be taken out, including the areolas and nipples (because cancer can travel to these areas as well), leaving my skin behind. Immediately following, Dr. Marshall will place tissue expanders under the muscles behind my current breasts. She uses Becker high profile tissue expanders which are part saline and part silicone (so they have a softer feel than other expanders that some women say feel rock hard). I will wake up from my surgery with anywhere between 220 to 300 cc's of saline already inside the expanders. She says I will look like I have an A cup. Then after I've recovered for 10 days and my drains (yes, drains!) are taken out of the sides of my breasts to drain extra lymphatic fluid and blood, I will get "fills" of saline every week or every other week to stretch the muscle and tissue. She prefers to fill at only 60 cc's per appointment until I reach the size I want. I will be happy to just get back to my current 34C's! I will have these tissue expanders for about 4-6 months, and then I will have an implant exchange surgery. Dr. Marshall explained thoroughly about this procedure and said when it comes time for the implants to go in, she will manipulate the surgical table to sit me up at a 90 degree angle while I'm under anesthesia so that she can see exactly how the implants fall. They will also move me around a bit from side to side to get the proper placement and make them look as natural as possible. If I can achieve results similar to the following examples of reconstructed breasts, I will be very satisfied.

This is before areola tatoos and the surgical tape is in place just to smooth out the mastectomy scar.

This is just 12 days following the implant exchange surgery ... the tatooed areolas were later moved to be more centered and nipples were later followed by the "twist and stitch" method as seen above.

I'm so glad to have a female plastic surgeon in many ways because I could tell from our consult that she would be VERY SENSITIVE to my cosmetic concerns and still do the best she can to make me feel physically comfortable at all phases of my reconstruction process. If I thought I was the bionic woman following my port surgery, I am really going to be built up now! I'm ready to just get this initial part over with so that I don't have too much more time to think and feel anxious. The longer it takes, the more upsetting I think it will become. I'm just looking forward to being on the other side of all this soon.

Do you want the good news or the bad news?

The good news is I will NEVER have to worry about a recurrence with breast cancer. The bad news is my surgery was cancelled today because I am going to have to have a mastectomy with immediate reconstruction. I know, I know ... I am just as shocked and devastated by the news. I'm okay with it all now, but just really, really tired from a very long, involved day. I am cheating and simply posting what I wrote earlier to my YSC sisters at my online support group. (I will post more in the coming days ... but my head is still reeling with the surprising news ... and I just want to lie down. But I also wanted to keep everyone updated for the moment. I know so many of you were thinking of me today and had me in your prayers. I so appreciate that and really do feel all the love.)

I am home now, but in such a DAZE. Still trying to get my mind around it all.

A recent MRI confirmed that chemo shrunk the two tumors I had significantly. However, the mammogram I had today to assist with placement of the wire guide showed I still have DCIS (ductal carcinoma in situ or "precancer" confined to the mammary ducts) extending over a large 4-5 cm area. Apparently, an MRI can pick up invasive cancer, but it does not show DCIS so it can be misleading.

Anyway, my surgeon told me he could try to do a wide excision but he could not assure clean margins with the extended area of DCIS. On top of that, it would leave my current 34C breast pretty deformed and he didn't feel it was ethical to try for a lumpectomy. So the decision is made, I guess.

I consulted immediately with a plastic surgeon my surgical oncologist recommended and praised highly ... I was truly a squeezed in appointment. However, I did not leave the PS's office feeling completely confident. He did tell me he could try for skin sparing with me, but he would prefer more "droop" in my breasts to do an "anchor" incision (from the nipple downward and then one curved incision on the underside of my breast). Otherwise, he would work with whatever incision my surgeon used (diagonal or straight across). For all that I've learned on this website, he didn't give me a straight answer on what type of implants he would use (i.e., high profile, moderate profile, teardrop, gummy bear, etc.). Instead, he said he is more concerned with reconstruction that won't create more complications for me. In other words, if he tries to do everything I want for purely cosmetic reasons, it could possibly cause more problems for me ... so cosmetics is not the foremost priority. I am paraphrasing here cuz I can't really remember everything he said specifically. I get what he was saying about my health being the priority, but why can't I also strive for a FANTABULOUS result?? He left me feeling like I won't have the great looking breasts I have now, but they will be about the same size and more "mature looking" (these were his exact words). WTF does that mean???

The pics I saw of his work looked GREAT for cosmetic breast augmentation and breast reduction. But he only had ONE photo of reconstruction after mastectomy with expanders/implants to show me ... it was just OK. His book was pulled apart for a consult he was doing earlier, and he said he'd have to locate the others and he didn't have time at that exact moment. Understandable given the time constraints of my non-appointment, I guess.

I know I have a lot to consider in a short amount of time ... my surgeon doesn't want to wait too long (i.e., more than 2 weeks) since I've finished chemo and doesn't want the cancer to start growing again. But I do want to assure myself that I can get GREAT results ... I know it's possible because I've seen plenty of examples here!

My head is still reeling from all this and I cried a good bit because I thought they were forcing me to make a decision about having a mastectomy TODAY. I'm now okay with it all ... I just want to make sure I can find a good PS ... oh, who also has privileges at the same hospital as my surgeon (Baptist Hospital in Miami) ... the other challenge here.

This whole experience seems so surreal ... I can't even believe I'm talking about MYSELF when I tell people about my battle with breast cancer.

Couldn't resist this one ...

Just kidding.

But you know what they say ... misery loves company. (Tee hee!)

Surgery date is finally here!

I am FINALLY having my surgery tomorrow (May 17th) at Baptist Hospital in Miami! Truly, the day can't come fast enough for me. It will begin at 7:30 am with a pregnancy test ... nevermind that I've already said there is no possibility that I'm pregnant ... they simply won't take my word for it. At 8:30 am, I will have a needle wire guide inserted in my left breast so that my surgeon will know exactly where to work. (Have I said if you're afraid of needles, cancer is not the thing to get??) At 11:00 am, I will move to pre-op to presumably get undressed and have an I.V. stuck in my arm. (I always try to predict where they're going to stick me and lather on my EMLA or lidocaine -- skin numbing cream -- ahead of time!) At 1:00 pm, I am scheduled to breathe deeply and fall off to a deep sleep. But not before I make sure my surgeon, Dr. D., has said he had his breakfast or lunch and a good night's sleep! Afterall, tomorrow is not the day for him to feel sleepy at work ... you know what I mean?

I'm really OVER all the annoying, lingering side effects I've been experiencing from chemotherapy. Boo, hiss, boo! I was told I would have an easier time with Taxol, but to date, let's see ... I'm up to 129 lbs. (or 20 lbs. more than usual for my tiny frame), I have unsightly acne scars all over my face, chest, and back, I've lost my eyebrows and lower eyelashes, I'm experiencing extreme edema or swelling in my hands, feet, and legs STILL, I have painful nailbeds that look bruised under the nail ... let's see, what else? Oh, hot flashes strike without warning about 4-5 times per day! It's worse at night when I'm trying to sleep ... covers on, covers off. And I'm a bed hog now ... looking for any cool place for my Fred Flintstone feet!

I know I sound like I may have nothing good to say. Believe me, I am soooo very appreciative of my team of doctors and extremely grateful that they encouraged me to have the most aggressive treatment to date ... I'm especially grateful for all my earth angels (friends and family who have been soooo incredibly supportive of me these past several months) ... but I'm feeling as though I'm starting to hit a wall now. After surgery, I still face 7 weeks of radiation treatments (every day, except weekends). They will likely want to tatoo me with teeny tiny dots in several places around my chest so they can line up the radiation beams each day. I simply don't want tatoos if I can help it. I would rather they mark me with permanent marker that I will be more than willing to cover up with surgical tape to keep from washing off. I'm not even sure if this will be a possibility, but I'm going to argue for it. On top of everything, I worry about those radiation beams hitting too close to my heart and my left lung. Ugh.

Overall, I feel like I've put up with enough already ... hair loss, risk of damage to my fertility options, fatigue, etc. and all with a positive, great attitude for the past 8 months or so. Breast cancer takes so much from you physically and emotionally ... it feels like a constant challenge to not let this dreadful disease defeat your spirit and self-esteem. I'm just trying to remember that things could be a lot worse and keep it moving forward. The best part of my day tomorrow will be my ability to say, "I HAD breast cancer!" :-))