Something's Got To Give

Recently I started to get stressed out thinking about all the things I've got on my plate:

Working full-time; school part-time; 2 incomplete courses to make up; new courses starting January 24; dietetic internship application due February 15; surgery February 18; Tamoxifen & IUD to adjust to...aaahhh!

Just over a week ago I came to terms with the fact that I knew I just could not handle it all. It would be too much for anyone, let alone someone being treated for, recovering from and coming to terms with their cancer. I was at home drinking wine (no surprise), watching an episode of Thirtysomething on Netflix (hey, that was an award-winning, critically-acclaimed show that I was too young to appreciate or even have permission to watch at the time it was on the air!) and generally puttering around trying to figure out what to do. Almost as soon as D walked through the door I blurted out something like "I just cannot do it all! It's impossible! Something's got to give!" (Maybe all that Thirtysomething & wine made me a little more dramatic than I needed to be?) After staring at me with total calm and lack of any reaction, he casually suggested "Well, maybe you just don't take classes this semester," pointing out that the Master's level courses I was about to take were not necessary in order to continue moving toward my internship and RD exam. (Why does he always have to make everything look so easy and obvious?) He was right. If I couldn't do it all, I needed to make a move and taking a semester off was probably the best course of action.

So that was toward the end of last week; however, it wasn't until the weekend that I felt absolutely certain that I needed to do this. Monday was a holiday so first thing Tuesday morning I set to making about a million phone calls to find out exactly what I needed to do and make sure I wasn't going to be penalized in any way. Was a medical leave of absence the right choice or were there other options? Could a leave be processed in time for me to drop courses by Monday the 24th (the last day to drop and get all your tuition & fees back)? Would I still have access to my online account (the portal that gives you access to your school e-mail, all the information you need for your courses and all the library materials available electronically)? What would happen to my loans? What would happen to my scholarship? What did I need to fill out or provide in order to process the leave of absence? Believe it or don't believe it, getting the answers to all these questions and getting a doctor's note from my doctor took much of the last four days (including today). Just now, in the process of writing this, I received confirmation that my doctor's note was received, my leave will be processed and my classes will be dropped for me. Phew.

So, what's next? Well, did you SEE that To Do list above? I've got about 3 weeks to get my dietetic internship application completed and submitted, so I'll be working on that. Also, 3 days after that is due I have my next surgery, so I'll be spending the next few weeks preparing for that, both mentally and with pre-op and follow-up doctor's appointments.

Meanwhile, I don't know if you even want to watch this, but this is the story, aired on the Today show (gotta love Meredith, Matt, Ann & Al), of a little 3-year-old girl who was diagnosed with a very rare juvenile form of breast cancer. Thankfully, she is now cancer-free and her prognosis is good. Insane.

Breast Reconstruction is NOT Breast Augmentation

Let's get something straight. Having breast reconstruction surgery is not the same as getting a boob job. "Who would think that?!" you might ask, appalled. But plenty of seemingly well-meaning people have said some pretty crazy things to me about my soon to be new boobs. I think people want to say something positive and so the first thing they think is "well, you get a free boob job in the process!" or "well, you'll have perky boobs for the rest of your life!;" however, for many of us going through reconstruction, it certainly doesn't feel that way. Don't get me wrong, I've read some comments from people who were never happy with their breasts or their body and are actually happier with their new boobs or with the tummy tuck they got through TRAM flap surgery (transverse rectus abdominus myocutaneous; a procedure in which the new breast is made from abdominal tissue). On the other hand, several women I've spoken with, who have already had reconstruction, are very unhappy to have had to go through this process and are very unhappy with the boobs they now have.

Let's think about this. A breast augmentation, or "boob job," involves adding an implant to an existing breast, without altering the function of the breast and while minimizing scarring as much as possible. You can take out your implants later, if you change your mind, and still have your breasts there. As long as your breasts were functioning before, and as long and you suffered no complications from the surgery, you can still breastfeed. You still have sensation. You still have an areola and a nipple.

Mastectomy plus breast reconstruction involves removing the breast tissue, plus skin and the areola/nipple area (in some cases the skin, nipple and/or areola are able to be spared). Your milk ducts and lobules are gone. Your nipple and areola are gone. The skin loses sensation and becomes numb to the touch, so you can't feel anything over most of the breast area. Typically, and in my case, a tissue expander is placed and the remaining skin is stretched to make room for an implant. The implant will create the shape of a breast, AKA a "breast mound," so that you can wear normal clothes & bathing suits without worry, but is not actually a breast. You can't breastfeed from the affected side anymore. If you lose or gain weight, the "breast mound" will not grow or shrink with you (same during pregnancy). I like to think of it as a permanent/semi-permanent (sometimes implants need to be removed or replaced) subcutaneous prosthesis. It sits there, under your mastectomy-scarred stretched skin, taking the shape of a boob so that no one will notice as long as you're dressed. If you want, you can have your plastic surgeon fashion a new nipple out of the skin on the "mound" and you can have an areola tattooed around it (and the "nipple" colored in). You can also opt to have both the areola and nipple tattooed on. Apparently there are some great tattoo artists out there who can make some realistic-looking 3D nipples and areolas. Unfortunately, you never really get your nipple and areola back.

In my case, since I only had a mastectomy on one side, there is also the issue of altering the right breast to match the implanted boob on the left. This is the point where you should be thinking "Hang on, after all that you now have to cut into, and mess around with, your only remaining, healthy, intact breast as well?! That's crazy!" Yes, yes it is. An implant is round (unless you're talking the new-fangled teardrop shaped implants, which surgeons apparently are still figuring out exactly how to work with). This means that implanting the left side alone would leave me with one very round perky boob sitting high up on my chest and one normal, sloping breast sitting significantly lower. In order to make the two sides match I will need to have a slight breast lift (mastopexy) and a very small implant on the right side (to match the "curvature in the upper pole" that an implant gives, as my surgeon likes to say). Did I mention that since a breast lift involves removal of breast skin that I will also need my areola slightly reduced in size or else it will look tremendous sitting in the middle of my newly lifted breast? Did I remind you that this procedure leaves me with a bonus scar? You might be thinking "If it's so bad and if you're so unhappy about it, why do it?" Because it is the lesser of two evils. I am a very active person. I want to continue to be able to throw on my workout clothes, a bikini, a dress or a snug-fitting top and not worry about how my lopsided boobs look in them. I want to avoid having to wear a prosthesis. I want to be able to continue living my life as I always have.

That's what this is about. It's not about getting a boob job as a sweet concession prize for breast cancer. It's about preferring to just keep your own breasts, as they were given to you, but since that is not an option, doing whatever you can to continue to look as close to your old self as possible and to continue to live daily life as you had before.

There, I got that off my chest......literally!

Zumba & Tamoxifen

Tuesday was my first real day back in the gym. (During my third and fourth week of recovery I went to the gym a few times but walking incredibly slowly on a treadmill, doing everything I can to NOT pump my arms or bounce, doesn’t really count.) I went to my favorite class: Zumba! I didn’t know what to expect. Might I injure myself? Would I have the endurance to make it through the whole class? There was a teacher I’d never had before and the class was packed. I stood off to the side and tried to pace myself. The teacher came over to me and had me move into an unclaimed hole in the group so I could actually see her and the mirror. I was trying not to go crazy (remember: I LOVE ZUMBA!) but when the teacher clapped her hands and yelled at the class “let’s go!” I flung my arms up into the air and instantly gasped and pulled my left arm back down. I had felt a little tug. It was a sign that I really did need to be careful. Damn. So, imagine my horror when the teacher then gestured for me to come stand next to her. I can’t control myself when I’m front-center! I need to go all out! I did my best to find some safe ground between totally going out all and reverting back to my previous treadmill pace. I stayed up there through the end of the class. At the end, the teacher asked me if I was an instructor. I told her I had been certified but was not yet teaching because I have been sick for awhile. I didn’t feel like getting into it with her. I was glad though that she pulled me up there. Oh yea…I’ve still got it!

Yesterday was our first appointment with the medical oncologist that my breast surgeon had recommended. We have an appointment with a second oncologist scheduled for next week because everyone has been telling me that your relationship with your oncologist is such a long-standing, intimate relationship that you should really love the doctor you choose to go with. So, I figured I’d end up meeting with at least a few. The oncologist was super energetic, which caught me off-guard. On the other hand, she said exactly what I was expecting to hear, gave thorough and reasonable answers to all my questions, was personable and demonstrated that she can be flexible and take a patient’s wants and needs into concern (she said if we were just dying to have a child before 5 years are up we could talk about putting the Tamoxifen on hold and then finishing the 5 years after). At the end of the appointment she gave me a quick check-up and my first prescription for Tamoxifen. Outside, D and I discussed what we thought about her. We didn't have any strong feelings either way. Plus, I would only need to see her once every 6 months for a quick check-up and a new script. I haven’t yet cancelled the appointment for next week, but we’ll see what happens. I might just decide to stick with this lady.

Christmas & Kelly Choi

Christmas and New Year's were great, even if I they did sneak up on me. Since this whole crazy thing started back at the end of September, I completely missed the whole transition into the holiday season. Usually we cook a bunch of stuff for our Thanksgiving dinners with our families. This year we cut back a lot on what we were able to contribute. Then, there wasn't much opportunity to go Christmas shopping so I just made sure that my nieces and nephew and brother had gifts and my sister took care of everyone else for me. On Christmas morning D & I had our traditional Christmas breakfast of German apple pancakes and champagne. I think it was the first thing I cooked post-surgery (we were 3 weeks post-surgery by this time). We didn't have gifts for each other. It was enough that we managed to get our Christmas tree up! That night we realized that we hadn't even taken pictures (usually we take pictures together while opening presents), so we snapped one shot right before bed. The day before New Year's Eve I was getting my final fill at the doctor's office so once again I was not at all thinking about the holiday. Also, since it was still kind of messy out from the winter storm, we didn't have definite plans and weren't sure we wanted to leave the neighborhood. We ended up at the neighborhood restaurant where D's friends celebrate every year. We had a fabulous dinner and ended up staying to watch the coverage of the ball drop with everyone. It turned out to be a nice evening. Two days later, we visited some friends who just had their first baby. An adorable tiny little girl who they brought home on Christmas Eve, just in time for Christmas & New Year's! Though scaled-back a lot, we ended up having a pretty nice and stress-free holiday season and got to spend lots of time with family and friends.

Yesterday was my first day back at work. I hadn't been happy about it but it really wasn't bad at all. I went to lunch with my three girlfriends from work. We went to our favorite little Japanese place. While we were sitting there we noticed that a girl and a couple camera guys had come in and were setting up lights and a demo in a corner of the restaurant. It was Kelly Choi! Kelly Choi is apparently the host of Top Chef Masters but I know her from the food show I used to watch after work on NY1. I was super excited, as was one of my friends, but our other two friends just thought we were nuts. Excited friend waved over our server and asked him to see if Kelly wouldn't mind taking a picture with us. She was happy to oblige so we went over and Not-So-Excited friends came and posed with us so as not to appear so obviously unimpressed! (Kelly was insanely tall & thin and made us all look ridiculously short & pudgy, so I was asked to please cut out everyone from the pic, should I decide to post it.) Today, it's Day 2 back at work and my first day back at the gym. Zumba!

Notes to My Family: January 4, 2011

Hi Family,

I will try to keep this latest one short.

A couple things:

This past Thursday (the day before New Year's Eve), D, mom & I went for my third & final fill. It went fine as usual.

While we were there we determined that my next surgery will be February 18th. Everything is fine. This has been planned all along. It is the second part of the reconstruction process. The date is locked in but we have no time or even hospital confirmed yet. This is because the surgery may take place at Manhattan Eye, Ear & Throat Institute, which is a part of Lenox Hill. The surgery is day surgery/outpatient & Manhattan EET provides ambulatory surgery facilities. This surgery is much less intense recovery-wise. I'm out the same day & I only need to take one week off of work to just rest. The following week I still need to take it easy & maybe not workout and stuff but I can go back to work. There should be less pain & fewer drugs and no drains!

Yesterday was my first day back at work. I was not thrilled about it but it ended up being a pretty good day. I went out to lunch with my girlfriends at work and while we were there, Kelly Choi of NY1 came in with her camera people. I'm assuming it was for one of her NY1 food shows but I don't even know if she is still filming those since becoming host of Top Chef Masters.

This week and next we have appointments with medical oncologists. We'll see how those go. Hopefully good. I don't want to have to meet 20 people before finding an oncologist I like and while I don't really want to start the Tamoxifen, I also don't want to put it off forever.

I have started putting together the blog. Right now it is really just a place for me to collect my notes to you, some great resources that might come in handy for someone else and just little anecdotes I want to share along the way. I don't know what kind of access or restrictions I'm putting on it so let me know if you have trouble getting in.

Hope everyone had a Merry Christmas and Happy New Year!

Love, Diane :)