WARNING: I talk a lot about bras in this post

Today marks 3 months a 1 week since chemo... and I totally have the hair to prove it! Not to mention, 8 weeks and 3 days post-op. In honor of those really random milestones, I'm going to share with you something none of the cancer books out there will tell you. And that's that somewhere along this wild and wacky cancer journey, you find yourself at Target making purchases like this...

Your eyes do not deceive you. Exhibit A is the grown-up version of a training bra. And Exhibit B? Oh yes, those are in fact, fake toenails.

Pourquoi? you ask. Tissues expanders render bras effectively useless and unnecessary. I've heard from several ladies who, while under construction, abandoned the garment altogether. Their bras had become the appendix of their wardrobe. But despite the fact that I evicted my appendix (is anything else going to try to kill me this year?), the bra habit is a hard one to break. So is it too much to ask for one without ridiculous wiring or padding, that doesn't look like it belongs on a tween-aged girl or nursing home patient?  Where's that in the Victoria Secret catalog?

Fortunately something that isn't difficult to find is fake toenails. Now there's a sentence I never expected to write. For any of this to make any sense, we have to go way back to my post from October 10th where I wrote about some weird bruising under the nail of my left big toe. Long-ish story short, the nail took the last 2 months gradually lifting and finally fell off. I have my good friend taxotere to thank for that. So now I've got a yicky looking nub of a nail left. But instead of leaving you with a picture of that (ain't nobody got time for that), you get this one...


Me and Mom with Monica in DC. Remember all that post-chemo hair I metioned? That isn't it. That is vintage mink.



How's about a treatment update? Part I

Recently I came across a blog called the big scary 'C' word and realized two things. Number one: I've been a particularly lazy blogger. And number two: I haven't blogged much about what's next in the wacky world of cancer treatment. Namely, radiation and tamoxifen. This fellow blogger does a really good job of writing about both, pop on over to her blog to read up. Go ahead. I'll wait. 

Click HERE to read about radiation and HERE to read about tamoxifen.

Are you done yet? Okay, good. The first thing you may have noticed is that she refers to radiation as radiotherapy. The second thing you may have noticed is that she's British. Which should explain words like tumour and oestrogen. Both of which are driving my spell-check crazy right now.

Since I have been - as she puts it - foot loose and cancer-free since October, the new name of the game is preventing recurrence. Or - as the most recent radiation oncologist we met with calls it - a failure. There are two types of failures we're trying to prevent, local and distant. Local meaning the same breast cancer comes back in the same place, distant meaning the breast cancer pops up somewhere else. Like my bones. Which is apparently a popular spot for breast cancer to wander off. Perhaps cancer cells have sat through too many time share presentations. 

Now if you've been playing along at home, you're probably thinking "After a mastectomy, how can the same cancer come back in the same place?" Good question. All the breast tissue is gone, so where could the cancer come back...right? Right... a mastectomy significantly decreases the risk of local failure, and in turn greatly increases survivability. (Yes, yes MY survivability. Not the cancer's.) But local failure is still possible in the chest wall, the remaining axillary nodes, and internal mammary nodes. And for that we have a few lines of defense. 

Number one is the continued rounds of herceptin infusions I'll receive until next May. Lucky number 11 of 17 is coming up next week. 

Number two is adjuvant hormone therapy in the form of tamoxifen.The current plan is one pill a day for the next five years. But recent studies have found that ten may be more beneficial. Ten years that is, not ten pills. But that doesn't start until we know more about radiation. Which brings us to...

Number three. Radiation therapy. Rob and I met with a second rad onc (Dr. B) on Thursday. At the recommendation of the first rad onc (Dr. G). Dr. B was essentially in the same boat as Dr. G - though she did share with us some new information. New in that I don't recall having heard it before. Which is not to say that's actually the case as it's entirely possible that a few bits and pieces have slid past me in the last 8 months. Speaking of 8 months... tomorrow marks exactly 8 months of this wild ride. Are you all tired yet? 'Cause I sure am. Anyway... staging is the name of the game in the world of radiation oncology. Stage IIb breast cancer patients generally are not recommended for radiation because the potential benefits are not strong enough to out-weigh the potential risks. Stage III breast cancer patients, however, do see a benefit. Simple enough, right? Now what's the difference between IIb and III? Here's where it gets tricky.

Stage IIb involves a tumor between 3 - 5 cm and axillary node disease. Which I - for certain - had. Stage III also involves internal mammary node disease. Which - based on an MRI from April - is possible that I may have had. Because I've had both neoadjuvant chemotherapy and surgery since then, and all of the cancer is gone, there's really no way of telling now if there was mammary node involvement.So Dr. B neither strongly discourages nor encourages radiation. And Rob and I are left to weigh the pros and cons. 

But more on that later. For now, it's bedtime. And physical therapy comes awfully early in the morning. Round number five tomorrow!

UPDATE:You're Invited!

Saturday December 22nd

6:00pm
Uncle Julio's 
(14900 Potomac Town Place, Woodbridge)

Firebirds

(15100 Potomac Town Place, Woodbridge)

I know I talked a really good game about throwing a kick-ass "I Survived 2012" party. While we're not lacking in celebratory spirit, time and energy are running short. So we're going to let Firebirds Uncle Julio's do all the work. Join us there for dinner. Followed by birthday cake and cocktails - or birthday cake flavored cocktails - later that evening at our house.

This being my 32nd birthday, trust me when I say I understand just how hectic schedules can be this time of year. (My actual day of birth was in conflict with a Christmas party Mom and Dad were supposed to attend.) So give us a heads up if you can join us for dinner, or drinks, or both. And if you can't, raise a glass that night for all that you've survived this year. Cheers!

UPDATE 16 Dec:  We're moving the par-tay to Uncle Julio's. 'Cause fine Mexican food is much more fitting of surviving the Mayan Apocalypse. And birthday margaritas!

On the twelfth day of Christmas

My true love gave to me

(sing it with me now!)

Twelve weeks since chemo

Ten rounds of Herceptin

Six weeks since surgery

Three PT sessions

and 40 more CCs of saaaaaaaaaline

Rob and I finally made it back to the gym this week. Not too shabby for 6 weeks post-op, I'd say. I'd also say that 30 minutes of cardio...kicked...my...ass. Also, our gym opened a beautiful new facility complete with swimming and basketball. Neither of which I actually do, but I'm glad to see our membership money is well spent. And they've cleverly placed all of the cardio machines at the top of three flights of stairs. So I kinda feel like my workout is half-way finished before I've officially started.

In other news, my physical therapist is awesome. And only partially because she tells me I'm the smallest patient she's worked with. Which is only a little ironic, because I must have at least 15 - 20 pounds on her. She's tiny, but awesome. And my arm is already moving much more easily, which is also awesome.

What's not-so-awesome is still waiting on the verdict about radiation. To say Dr. G is very thorough would be an understatement. I like that about her. Despite exhaustive research, the risks versus benefits scale is still pretty evenly balanced. So I'll meet with a different Rad Onc next week and see what she has to say.

In the meantime, I got what should be my last saline injection in my tissue expanders yesterday. Another 40 cc's each side... I think. I wasn't really paying that close of attention. Let's just say, they feel quite full. TMI, you say?

Well on that note, I'll leave you with this picture of me and Mom waiting for Santa at the train station...

Unfortunately, we could not get Rob on a pair of ice skates. So you'll just have to settle for THIS ALBUM of other Christmas magic.

Na na na na na na na na na na na na na na na na... BATMAN!

Session #1 of physical therapy in done! One down, seven more to go. With the exception of one of the stretches feeling an awful lot like a brazilian jiu-jitsu paintbrush, I'd say it all went pretty well. And now I've got a handy-dandy sheet of exercises to work on at home in between my PT sessions.

Oh! And in addition to the axillary web syndrome, I learned that I also have a winged scapula. Also common in mastectomies with axillary node dissection.

So my should blade doesn't look nearly as bad as the guy's in this video, but the video is still pretty educational. And if you're not educated by it, then you'll at least be entertained by the narrator. His accent is fantastic!

And that is why I'm now adding Batman to my list of super-hero powers. Spider-Man... Batman... what's next? If I have to have radiation, can I add The Hulk to the list?

I like the Christmas Jesus best

Treating cancer is a little bit like saving money by buying stuff ('cause it was on sale). Sure, you get rid of the cancer. But in the process, you break a bunch of other stuff that wasn't broken before.

Today I met with a physical therapist for a lymphedema evaluation and to discuss the now limited range of motion in my left arm. Lymphedema is a common result of axillary dissection, and the rate of suffering from it significantly increases once you've had greater than 7 axillary lymph nodes removed. Because I'm now lacking 21 of mine it's a good idea to a get a baseline evaluation - even though I'm not experiencing any symptoms. The eval was helpful in that it also goes over ways to prevent developing symptoms. That includes wearing a compression sleeve when flying (I hope they come in different colors!) and avoiding repetitive motion. The PT's best example of this was scrubbing the bath tub, so I'm gonna say I'm off bathroom cleaning duty for a while. 

Impact on range of motion is also a pretty common side effect from a mastectomy and axillary dissection. So where my left arm used to move 180 degrees like it's supposed to, now it's closer to 120 degrees (lifting to the side) and 150 degrees (lifting to the front). To what do I owe this pleasure? Oh, just a little something called lymphatic cording. Which means I've got 4 weeks of physical therapy to look forward to. 

UPDATE: I just found that the other name for lymphatic cording is Axillary Web Syndrome. Here's a pretty good link explaining it. Also, I'm adding Spider-Man to my list superhero powers.

Now right here is where I was going to whine and complain about that. But decided instead to share this with you. Moxie as little baby Jesus. Enjoy!



So maybe that's not actually Moxie, but a very convincing likeness courtesy of a Christmas card I found at World Market.



What's new...

...since my last post? Let's see...

I got my fourth and final drain removed last Thursday! 

As a recap for those of you playing along home; post-op I came home with two surgical drains on each side. Both right side drains were removed on Day 10. One left side drain was removed on Day 17, and the other on Day 24. In case you were wondering, they kinda look a little something like this...

Should we talk about how much fun it is to shower and wear normal clothes with these hanging from you for over three weeks? No? Alright then... moving on!

After the last drain was removed, my tissue expanders received their second saline injection. Another 40 cc's on each side, putting each at right around 305 cc's. There's probably some very advanced math that converts expander cc's to bra size, but I have no idea what that formula is. I do, however, know that my regular, pre-mastectomy bras fit pretty well now. They're just really uncomfortable because the expanders don't move. At all. 

That means that I've got another week or two to let the expanders settle and relax ('cause no one likes an uptight tissue expander) before their next injection. Dr. M explained that once the right size is reached, he gives one additional injection - a 10% overfill - to allow the final implant a little extra room. So I may only have one more injection in my future. Woohoo! 

After the final injection, how long I have the tissue expanders in before they are exchanged for the final implants will depend on radiation (more on that in a minute). Here are the two possible scenarios...

Scenario #1: The radiation oncologist (Dr. G) gives me her blessing that the remaining tissue and nodes don't need radiation. Dr. M gives the tissue expanders a final injection in a week or two. And I can schedule the exchange surgery (exchanging the tissue expanders for the final implants) for 4 to 6 weeks after the last injection. 

Scenario #2: Dr. G does recommend I receive radiation in addition to the neo-adjuvant chemotherapy and bilateral mastectomy I've already received. Radiation would begin in roughly two weeks (they like to allow for 4 to 6 weeks post-op recovery). I would receive treatment five days a weeks for six weeks. Then... I would have an additional 6 months of recovery - allowing my skin to heal - before the exchange surgery. 

Now, to radiate or not to radiate? That is still being discussed and decided. According to Dr. G, here are the reasons to radiate...

1) My age. Because I'm young, my risk is high for the old cancer to come back or a new one to show up.

2) My cancer cells had a "high growth factor". Meaning they liked to move fast. 

3) I had positive lymph nodes. Again, the cancer cells were on the move before we stopped them in their tracks. 

And the reasons not to radiate...

1) My age. The radiation can cause damage to my heart and lungs. Which is bad in general, but worse if I plan to use them for the next 60 years. 

2) My cancer cells were triple positive (estrogen, progesterone, and Her2) and responded really well to treatment. Which is a good indicator that I'll have a lot of success continuing Herceptin and adding Tamoxifen. Meaning those two drugs are likely enough to keep me in the clear for the next 5 years. 

So that's the latest. Happy Thanksgiving to all! Try not to mow anyone down in your Black Friday shopping-induced excitement.