Pre-Surgery Update

I thought I would post one last update before my surgery.

It looks like everything is a go. After my low blood counts last week, I was supposed to have blood drawn today to make sure all my counts were still up. Unfortunately, my doctor's office failed to tell me that the lab closes at noon on Saturday, so when I showed up at 1:00, I was unable to get my blood drawn.

How weird is that, by that way? It's a hospital. You would think that there was somewhere in the hospital where you could get blood drawn on a weekend. I mean, the patients don't stop being sick on Saturday at noon. And, ER doesn't close down at Saturday at noon. You can't tell me that there is never an emergency that requires immediate bloodwork. So, that was a little frustrating. I did speak with my doctor this afternoon though and they're just going to run the tests on Monday. He indicated that they wanted to know whether they are going to need to do a transfusion on the day of surgery, so they're just going to arrange for extra blood, just in case. I suspect it will all be fine though.

In other, apparently not-so-related news, it appears that I have a superficial thrombosis in my right arm. In English, that translates to a small blood clot in a vein that is very close to the surface of the skin. They don't seem to worry too much about these types of blood clots. It's the ones that are in deep veins that they worry about. Those are the ones that can do scary things if they break loose. Normally, they would just treat mine with Motrin and a heating pad. Since ibuprofen thins the blood, it can help with minor blood clots like this. Unfortunately, for the same reason, I haven't been able to take Motrin for about two weeks because of my upcoming surgery. So, I can take Tylenol (acetaminophen doesn't thin the blood) to relieve the pain, but it doesn't do anything to lessen the clot itself. On the other hand, it's not getting any worse, so I'm not too worried about it.

So, as I said, all is a go. I arrive at the hospital at 11:00 on Monday morning to prep for my 1:00 surgery. The surgery is supposed to last for about 6 hours. As I mentioned in my previous post, my recovery from this surgery will be a bit more difficult* than it was for my mastectomy, and I'll be in the hospital until at least Friday, when my best friend Cathy arrives to stay with me for several days.

*I just read the blog of my friends Jason and Greta who had triplets at the end of the year. My recovery is nothing compared to the fight these three little miracle children have been putting up for the last month. They are truly inspirational!

Dave will be staying with me for several days after Cathy leaves as well. However, after that time, my friend Lori will be coordinating schedules for people who want to help out by cooking meals for me, driving me to doctor's appointments, or running errands for me. I've put my closest friends on that list as well as those of you who have offered to provide help after my surgery. (I've sent an email to each of you with Lori's contact information as well.)

Keep me in your thoughts on Monday and send me lots of positive, healing energy between 1:00 and 7:00 Eastern time. I'll be back for an update after I'm out of the hospital.

More Medical Fun Stuff

Okay, so it's not really fun. In fact, I haven't had a whole lot of fun since my last chemo treatment on January 5. However, I do want to share what I've been going through since I think it may help others who are going through chemo.

When I first diagnosed and before I had even begun chemo, I asked my doctor about my activity level. I had a lot going on at the time (for instance, I was preparing to shoot a feature length film while also working a full-time job) and wanted to know to what I extend I could expect chemo to impact it.

My doctor told me at that time that each person is different and that I should really just gauge how I feel. He also mentioned that, in general, people who are active tend to do better on chemo than those who are not. He didn't define what he meant by "active."

Throughout all last summer, I continued working full-time and shooting my film. We shot on an average of two days per week. One day was usually on a weekend and the other day on the evening of a weekday. In addition, I spent some time each evening preparing for the next shoot. Throughout all of this, the only time I really felt the effects of the chemo were on the day of my treatment or one of the two days following my treatment. During that time, I really never felt nauseous; I only felt fatigue. I could feel the chemo in my system. It left a strange sensation that I experienced both physically and mentally. I don't know how to describe it beyond that. But that seemed to be the extent of its effect on me.

Since that time, I've also had surgery and radiation. Of the three, chemo is by far the worst. Even though I was fortunate enough to never get sick, it was still the hardest to deal with. So, when I decided to have two more rounds of chemo in the last month, it was not an easy decision. It would have been much easier to not get more. I knew it was going to wear me out and make me feel bad, but for some reason, this time, it was even harder on me than last summer.

My first chemo treatment was actually pretty good. I had a similar experience as I had remembered it last summer. The first day you receive chemo, it can be like an energy shot for some people (me included). They administer it with a steroid called decadron that can give some people an energy boost. I received my first chemo session (in the second round) on December 20. That night, I went to see a local improv comedy show with a friend, and I felt great.

The next two days, I felt like I was recovering from a week without sleep. I spent the next two days just resting. By the 24th, I felt about 90% and drove 3 hours to stay with family over the holidays. By Christmas day, I felt pretty normal. Even my appetite was normal.

Unlike last summer, I wasn't very busy over the holidays. Once I returned home from visiting my family, on December 26, I didn't do a whole lot. I didn't work and I didn't do a whole lot of physical activity. Mostly, I just stayed home and worked on my computer (or, more appropriately, surfed the web). I noticed that I wasn't eating as well as I had last summer either. For most of the summer, I ate relatively healthy. I focused my diet on consuming a lot of vegetables and when I ate meat, I tried to make it low-fat. However, I had gotten into some bad eating habits after my surgery and particularly through the holidays. When I got back on chemo in December, I really didn't alter my bad eating habits much.

Then, I had my second chemo on January 5. That seemed to change everything. For the first time, I had a really hard time recovering from that chemo. Usually, within 3 days of chemo, I'm back up to 90%. Within a week, I felt 99% normal, except that I got winded and tired more easily than I had prior to chemo. However, with this last round, I found that a full week after my chemo, I still felt awful. I was battling semi-nausea most of the time. My appetite was nearly gone. I ate just to keep from getting sick. I was exhausted all the time, and my inability to sleep at night just made it worse. And, just when I thought it should be getting better, I started experiencing new symptoms that had me concerned about my heart.

This past Sunday, I started experiencing chest pains... not in my heart but sort of down and to the left of my heart, along the outer left edge of my chest wall. The pains always seemed to accompany periods when my heart would start racing and I'd have a brief moment where I was short of breath. Of course, the first thing that concerned me was the effect the adriamycin (the chemo drug) was having on my heart. I already knew that a certain amount of adriamycin could pose a cardiac risk, but I also knew that I was supposed to be well below that threshold.

When the pain and racing heart didn't get any better, I called my doctor. That morning, when I first woke up, I took my resting heart rate. It was at 100 bpm before I ever got out of bed. When I called my doctor's office, they managed to schedule an EKG for me the same day. By the end of the day, I knew it wasn't my heart. The EKG came back clean. So, they asked me to have some blood drawn the next morning.

It turns out my blood counts are really, really low, so they scheduled a blood transfusion for me tomorrow. I don't know why, but I really don't want to have it. By yesterday, my symptoms started going away. Today, I actually feel pretty good. Before I have the transfusion tomorrow, I'm going to have them check my blood counts again. I don't want to go through this unless I absolutely have to. The nurses tell me that it won't make a difference, that it's extremely rare for someone's blood counts to just start rising again on their own. But, I'm a rare individual, so I'm going to check anyway.

So, I wanted to share that I think I am walking proof that the more active you are, the better you do on chemo. Instead of stopping all activity, maybe just slow it down a bit. If you were jogging three miles every day, you might want to slow it down to a brisk walk. Or you might want to only jog a mile. That's up to your body to tell you what it needs. But, my suggestion is that you don't immediately retreat to your bed or the couch and wait for it to pass you by. I think you will feel a lot better and have an easier time on chemo is you stay active. That was certainly my experience.

Phase 2 Begins

With yesterday's chemo, I've completed the initial treatment phase, and now we move into the ongoing, long-term treatment phase. We can probably consider this the maintenance phase.

During this phase, I will get reconstructive surgery, which I am scheduled to get on January 29. For those of you who don't know, my reconstructive surgery will consist of a TRAM placement and an implant replacement for my expander.

The implant replacement should be fairly easy. Since my mastectomy, I've had an implant expander in my right breast in order to stretch out the skin and any remaining tissue in the area to make room for the implant. They'll remove that and replace it with the permanent implant.

The TRAM will be much harder. The TRAM is necessary because they removed so much of the skin and breast tissue on the left side that there really isn't enough skin to stretch it out for the size breast that I'd like to have. I've requested C-cups by the way. Previously, I was a D-cup, so this is a reduction for me. But, I think to reduce any further would have left me looking disproportional. I talked about it with a friend when I made my decision, and she agreed that a C-cup is probably the right size for me. This also just felt like the right size for me. I felt like I would still feel like me.

Anyway, during the TRAM, they move the fat and small piece of muscle from your adomen and use it to shape your new breast. They also have to remove one of the two of the blood vessels that carries blood into the area (which serves to strengthen the other one), but they did this during my mastectomy. It's called a delay and, since it's had all this time to get stronger, hopefully it won't have to work quite so hard to make sure my TRAM gets enough blood to get and stay healthy once it has been moved.

I didn't have enough fat and, particularly, skin on my belly to do both breasts, which is why I'm doing an implant on the right. And, we didn't have enough skin on the left to do a implant on both sides. So, the doctor ordered up one of each, and I agreed.

Since they have to cut into the muscle on my abdomen for the TRAM, the surgery is harder to recover from than my mastectomy was. So, they'll keep in the hospital a little longer. The surgery itself is scheduled to last 6 hours, which is a little longer than my mastectomy lasted as well. I won't notice the difference in time. For me, my mastectomy passed in the blink of an eye. If my TRAM surgery lasts longer, maybe it will feel like two blinks, but probably not much more.

I will definitely want some friends around on my day of surgery and to visit me throughout my hospital stay, but I suspect that I will also want to sleep a lot. That's my standard M.O. when I'm not feeling well. Sleep through the pain and general yuckiness, and wake up feeling better. Both Cathy and Dave are going to be staying with me for several days after my surgery until I can get around a little better on my own. If her work schedule permits, my sister may also be here for a couple of days during that time as well.

After I've recovered somewhat from my surgery, I have another doctor's appointment with my oncologist, and that's when I'll start on the Tamoxifin. That will officially put me into the next phase of my recovery.

While on one hand, it seems like that last year has been a long journey to get to this point, on the other hand, I can hardly believe it's already here.

MRI Results

This will be a quick post, but I wanted to update you on the results of my MRI.

As you know, I had an MRI done on the Saturday before Christmas. I expected to get the results the following week, but the doctor was out of the office that week, so I didn't get them until today.

It was all good news: they didn't find anything at all.

The interesting thing is that I was kind of nervous about everything until the day I went for the MRI. As I was laying in that narrow tube and they were running all the scans, I suddenly thought to myself, "They're not going to find anything." In that moment, I knew there was nothing there.

Since that moment, I've been at complete peace about the MRI. In fact, the speech stuff seems to be subsiding. Perhaps it's because I'm drinking more fluids now that I'm back on chemotherapy. Perhaps it's because I'm so at peace with it that I'm not noticing it anymore. Either way, today they confirmed that they didn't find anything.

This just helps me feel validated that I'm doing all the right things and am far along on my path of recovery.