Crawling Out of the Information Quagmire

WHEW. That was a crazy long bit of too much. I've moved back to my house, I'm still unpacking, our Argentinian, long-time friend Alejandro Gee has moved in as a roommate upstairs (into what Hogarth calls "The Tango Palace"), and John & Amity our best friends downstairs have bought a house and are moving (sniff... sniff...sniffsniffsnifffffffff) the beginning of August so we are on the search for new tenants. And I've been to another billion appointments and struggling with: which surgery and which surgeon to pick. And I have. YEY.

Please don't get me wrong: I know I am SO lucky to have options. But I never envisioned my process being this way. And I did not foresee how unbelievably stressful this decision would be (and still is). I am not comfortable deciding the fate of my body. Which doesn't make sense because isn't that the ultimate luxury in medicine, to make your own choices?

I originally went to Surgeon #1 and thought I'd leave that meeting with her telling me exactly what my surgery would be. Wooo-weeee, was I ever wrong. Instead I left there totally exhausted and confused after she said I could pick what I wanted to do (again: this is GOOD!). Surgeon #2 (at a completely different hospital system) said the same. #3 said he would definitely NOT do a mastectomy because of the lump's closeness to my pectoral muscle, he felt he could not get good enough "margins" (they want to cut a minimum distance away from the tumor to ensure they got a good clearance of the cancer cells) and he would not cut into the muscle. Therefore I would need to do lumpectomy with radiation because with mastectomy I most likely wouldn't get radiation and therefore there would be too much risk of cancer cells left behind near the muscle. So I was set on lumpectomy for sure. I went back to surgeon #1 and she concurred. Deep breath...

...Then I saw a plastic surgeon to see what he thought. He told me to choose #2 as my surgeon since I liked him best and then he went through all the reasons why a mastectomy could have better cosmetic results for me so I could be aware. And -- oh great, yet another option! -- I could start with a lumpectomy, see how it turns out, and if it's terrible aesthetic results, go back in for a second surgery and get a mastectomy.

Now I have no idea what to do except... I know I want Surgeon #2. I went back to #2 and he said he would cut into the muscle and it wouldn't be a big deal, thereby putting mastectomy back out as an option. In the end he told me to go see a counselor about trying to pick which surgery, since all surgeries will cure the oncological problem. The rest was aesthetics, process, and lifestyle decisions that I need to make... and only me. I did see a counselor. But actually what really helped was meeting a radiation oncologist who was so completely fabulous. She reinforced my feeling that I should do what the plastic surgeon said: start with the lumpectomy and see how it goes from there.

Somewhere around seeing that plastic surgeon is when serious headaches started disabling me and I began having really big problems with words. Like "please shut down the rainbow" means "could you lower the volume on the radio, please." Names of people -- HA! Unless you're a doctor I forget them. I don't care I've known you forever and you're my sister, you're still sometimes What'sHerFace. And a really weird side effect: I cannot remember how to efficiently drive from point A to B anywhere around Seattle. My mind-maps are blown to bits. And I stare off in space with exhaustion. Please wipe up my drool if you see any. Ever try to learn another language in a crash-course, immersion kind of way? It's a lot like that.

And I am HEALTHY. I do not understand what people do when they don't feel well and have to do hospital things. This is why I pray to the Great Chemo Gods that I won't have to go through that. I am terrified of chemo. I digress. As I was saying, this is all just mental and emotional exhaustion. No meds yet, no nothing. Just a severe case of being super overwhelmed with information and indecision.

Lumpectomy vs. Mastectomy
So here was the problem. Appointment after appointment, tons of reading material, talking with breast cancer survivors... all of this information kept getting revealed and I still never liked the choices. They all sucked. But which sucks the least? Who knows. Breast cancer is different for every woman so it's hard to know who's profile you match the closest too. In the end it's really your own personal decision (when you have choices...). These were my options.

Lumpectomy (this is verrrrry basic):
-Tumor is removed but because of the breast tissue left behind you HAVE to do radiation to make sure you kill off cancer cells left in the tissue
-Radiation treatments for me would be Mon-Fri everyday for 6 1/2 weeks (10 minute appointments but a 20-minute drive each way.)
-Because you are basically getting burned, radiation toughens up the skin and tissue making it almost impossible to get reconstructive surgery (picture bacon, but this happens microscopically)
-You have a slightly higher rate of breast cancer returning because there is breast tissue left behind
-There is a 1-3% chance that sometime later in life you could develop a totally different type of cancer from the radiation -- and these are usually not curable cancers
-Radiation can hit and damage other parts of your chest cavity, heart and lungs
-Sometimes your breast can shrink a full size (Hello! I'm already A-ish...)
-Where my tumor is and the skin that will be removed could make one nipple higher than the other, mmmhhmm... lopsided
-Where the tumor was removed it could look like a big chunk is missing. Up to 30% of my breast could be removed, and I might be deformed, certainly no longer symmetrical. I might tell people I wrestle alligators for a living.
-Or everything could look great. That's the problem with this, you just don't know the visual outcome, till the outcome
-BUT... I would still have MY breast and it would have sensation and continue to live and be a body part
-I keep forgetting to ask if I can get a tattoo where the skin has been radiated. Something is definitely going there when this is over...

Mastectomy (again, super basic, broad statements):
-Remove all breast tissue
-Depending on the tumor location, this usually means the nipple is removed as well
-Later, with WAY-better-than-Frankenstein reconstructive surgery, a fake nipple is made and tattooed on
-GOOD: I most likely would not have to do radiation (since lump and all tissue have been removed)
-SO, you can get great reconstructive surgery. But it is not like a regular boob-job. Those the implants go under breast tissue and muscle and there is still sensation. With a mastectomy it's just implant and then skin. My friend's mom said her implants are "lumpy, a little mushy."
-There is little to no sensation in the entire mastectomy area, which can also continue up into the armpit. It feels numb.
-My other breast would get a normal boob-job implant to match
-I'd have the mastectomy surgery, then two months later they put in these bags that stretch out the skin, then two months after that they put the final implants in (some plastic surgeons put those stretchers in at the time of mastectomy surgery; mine won't because he doesn't like the risk of infection). A six month dealio.
-Also GOOD: it would decrease the chance of breast cancer returning some (since there isn't tissue for it to return to)

This is like 6 weeks of information and opinions about my particular lump boiled down to some basics that leaves out a whole lot, but you get the gist. It seems so odd that all of the doctors are so brilliant and yet all have slightly different opinions and takes on information. (Like the radiation oncologist doesn't think my breast will shrink that much.)

Halfway through I took the option of double-mastectomy totally off the table. I'm only going to deal with the one breast with problems at this time. The other one right now is healthy and I'll just go with that. Also, a 4th option was thrown into the mix. Because of my tumor location it is possible to do a nipple-sparing mastectomy. They leave your nipple but remove everything else. Again, breast cancer reoccurance is slightly higher because a nipple is breast tissue and you are leaving it behind. The nipple is dead though. It does not react to anything like temperature and it too is completely numb like the rest of the breast. And it might not take after the surgery and could die off. However, I liked this psychological option as I was COMPLETELY freaked out about losing it entirely.

For some people there might be factors that guide them clearly in one direction or the other. I'm in the group of the clearly undecided. My strategy for a long time was that as long as I didn't decide, then there wasn't a decision, and therefore no surgery could be scheduled, and this all wouldn't be happening. Lalalalalalalaalalalalllaaaaaaa. (I'm learning the true meaning of denial.) Well, the clock is certainly nipping that theory in the bud.

This is where Super Lisa comes in. Whenever I see a picture of Lisa I see an imaginary caption underneath that quotes what Rob once said, "Lisa might be the smartest person we know." And Dr. Rob Crampton, PhD has a lot of smart people in his life. I know, right? -- Wouldn't you bring her along too??? Well, that's a good enough resume for me, and poor, poor Lisa got recruited into my world of nuttiness. She met my oncologist, plastic surgeon, surgeon #2, and the radiation oncologist. She also got in on the film-losing-escapade. One day she said, "I don't know how you aren't all googly-eyed at the end of these days" ...since she was all googly-eyed too. Oh, which I am by the way (see drool comment above). You can't help it.

This is how awesome Lisa is with helping me sort out all this information. Every time I drop her off from one of these insane appointments we decompress all our new facts. Somewhere along the line she decided we needed a decision tree before our heads popped off. Look what she made me. This isn't finished, it is in Phase 1 of production:


She also typed up the notes she took at our appointments. Have I mentioned enough that I have the most amazing friends? I am one lucky dog. Here is Lisa. She's super beautiful (and single too. All my single girlfriends get a free promotion when starring on this site.) We had a great time doing a jigsaw puzzle waiting for one of my always-seem-to-be-delayed appointments. Note to hospitals: I would have happily waited hours for the appointment with that puzzle. In fact, it was hard to pry us away once Lisa found the LAST edge piece. Yes!

Lisa, possibly the smartest person we know

Soooooo.... Surgery D-Day is Thursday, July 30th. Julie What'sHerFace, my sister, is coming up from Portland to stay with me and take me to Overlake Hospital. They'll cut out the lump and send it out for tests. They'll test all six sides of it and make sure there are enough healthy cells surrounding all of it (those pesky "margins.") If they cleared the margins enough, then I'm done for now. If not, I need to go back in a week later and either get more breast removed, or just go for the whole enchilada mastectomy thing.

If the lump tests ok, then I go to the plastic surgeon. Using a needle he will aspirate the fluid that fills up the lump's hole. (The fluid is the body's way of trying to heal and makes everything look puffy and nice post-surgery -- but it will get zapped away with the radiation. Kind of like when you see a souffle in the oven and then it totally collapses later on.) With the fluid gone, we can better see what my breast will look like after radiation treatment. At this point (ok, check the Decision Tree now) I can decide if it looks good to me and 3-4 weeks later start radiation ... OR if I feel like a deformed freak, I'll skip the radiation and sign up for a nipple-sparing mastectomy so I have a shot at reconstruction.

Basically we know all that we are going to know until after surgery. During surgery they put a blue dye or some radioactive gunk in your breast and it sends it up into your armpit and shows the surgeon where your lymphnodes are. He cuts into your armpit and removes some of these nodes. This is the Sentinal Node Biopsy. They test them right then and there. If they are positive, then they go for removing more nodes. If negative, then it looks like the cancer is pretty local in your breast. But they get sent out for further, better tests as well.

At surgery is also when they can tell what stage your cancer is officially at. They also can tell if there are tentacles to your tumor and if they are spreading beyond the breast. They also do another test that I forget the name of. That's for the oncologist, so they'll know better what your deal is as far as the cancer being in your system or just localized. So, it's not until after surgery that I'll know if I need chemotherapy or not.

But we're not going to talk about that, because I am not going to have that, in my mind. But if it happens, I'll have a lot to deal with then, but right now I have other things to worry about, I'm not putting my energy into the possibility of chemo. Like, I'm not sure what shoes I'm wearing to my friend Sarah's wedding on the 25th. (Can't wait, can't wait, can't wait for that!)

My lump is slow growing, non-aggressive, well-behaving (if there is such a thing) cancer. Most women my age have cancers that are akin to a Bonnie & Clyde rampage, shootin up the country-side, robbing banks, spraying bullets, balls-out, taking no mercy. My cancer appears to be like the 70-year old woman fed up with her nasty husband and sprinkles arsenic every night on his meatloaf. So, chemo is hopefully unlikely, but not ruled out... till after surgery. I'm so sick of hearing with everything, "We'll know better after the surgery..." Aye yi yi...

All I know is that I will sleep better after this surgery... oh wait, that's right! For two weeks you can't sleep on that side of your body and it's really painful. Will someone tell me what's the good part of having (early-detected) breast cancer? Oh yeah... you get to live. Alrighty, I'll take it. YEY!