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March and April 2014: Surgery and Preparation for Chemo

ejourneys's picture

Day After Surgery (copied from a blog post dated March 26, 2014)

I posted this as my Facebook status earlier today:

Home and mending! M and I both earned our Tough Old Broad merit badges (this needs to be a thing). Many thanks to the [hospital] staff and volunteers for taking very good care of both of us. Thanks also to [cab driver] for his patience and flexibility in waiting for us, because my BP refused to climb. Staff made sure I was asymptomatic before they let me go. I said, "Fitness'll do that to ya." My tumor was removed with clear margins (very good news); lymph node pathology report should be in when I have my post-op appointment next week, day TBD. Thanks for the awesome prayers, healing vibes, and mojo, everyone! <3 <3 <3

I'm moving pretty slowly and dealing with a fair degree of soreness, though not a lot of pain. My chest sports the latest in Bride of Frankenstein Couture, but Dr. C did a great job. Time and reduced swelling will tell, but I suspect my shape hasn't changed all that much. Given my other scars, I'm pretty blase about that.

What was promised to be a long day became that much longer, due to:
1. Early pick-up (going in, we shared the cab with another passenger who had to get to the airport);
2. Surgery delay of 45 minutes because the guy ahead of me took longer than expected;
3. My body's stubborn insistence on keeping my blood pressure low; and
4. An extra stop at CVS to drop off my Rx, because the Walgreens staffer who does bedside Rx service for the hospital is on vacation.

Hospital staff was tremendous. M brought her food arsenal wth her (muesli, salt, magnesium, water bottle), which barely got her through our 12 hours spent at same-day surgery. Staff also gave her coffee and a warm blanket and she had her own lounger in the prep/recovery room. A patient liaison kept us both informed. I also got warm blankets and then the freakin' awesome Bair Paws, which provided a constant heat source. And we had the great nature scenes/ambient music C.A.R.E. channel, which was perfect.

My lack of sleep the night before and our early pickup meant that M and I got to the hospital in plenty of time. That let me really relax prior to all the prep, which helped tremendously. Sleep deficit was great for putting a damper on any anxiety I had, because I was at the point where I was just too tired to get worked up.

I'd been warned about the lymphosinctigraphy shots, which is where I was injected with radioactive tracer to zoom in on my sentinel lymph nodes. The lymph nodes (four in my case) were removed and will be biopsied to see if the cancer has spread. I should have those results by the time of my post-op visit in eight days.

Four nodes meant four shots. The nuclear medicine guy apologized for the pain, which couldn't be helped -- I said, "I'll just make a face." The first shot was painful but manageable, the second shot was less painful, and the third and fourth shots were like a walk in the park in comparison. I then had to massage my breast for 20 minutes, followed by holding still for three different angled imaging sessions that each lasted a fair amount of time. All in all the procedure took about an hour.

Nuclear medicine guy was doing the procedure on two of us simultaneously. During the imaging he was literally running from me to the other patient and back. He made sure to keep all the details straight. His bedside manner reminded me of The Doctor from Star Trek: Voyager, but I could tell he cared a lot about what he was doing and about his patients. I felt both safe and somewhat entertained.

M was a real trooper through it all. She admitted to tearing up a couple of times, but for the most part she was able to keep her high anxiety in check. I had given a memo to the staff when I checked in, asking that they keep her comfortable as much as possible. All things considered, she really came through yesterday.

My surgery lasted a couple of hours. Last Friday my pre-op had included an electrocardiogram, which the anesthesiologist told me was "rock-solid normal."

The anesthesia knocked me out lightning fast. I remember being wheeled out of the prep room and maybe a few feet down the hallway; the next thing I knew I was in a recovery room attended by two people, one of whom fed me an occasional ice chip. On a scale of 1-10, my pain level came in at an 8, which they reduced in time to between 2 and 3 before I was moved back to my own prep (now recovery) room.

There I was able to start with a bit of ginger ale and then graduated to graham crackers. I'd had nothing to eat or drink since midnight the night before, so those crackers tasted orgasmically good. From here on in we waited for my vitals to stabilize.

My BP on entrance had been something like 111 over 60-something. That's generally considered low, but it's not unusual for me during my periods of fitness. Technically my discharge should happen when my BP is within 10 percent of what it had been at entrance.

My body had other ideas.

I lost count of the number of BP readings taken. For the most part my numbers refused to budge. Not having heard from us, our cabbie called the hospital, himself. Then he was left waiting while I felt like a little kid on a long drive: "Are we there yet? Are we there yet? Are we there yet?"

After it was determined that I had been asymptomatic during the final few readings (e.g., no dizziness), I was discharged with a BP of 79/42. My pulse was 54 bpm, respiration 16 breaths/minute. I'm mellow. :-)

During recovery I also noticed that my drive to nap competed with my need to breathe. I had no difficulty breathing at all, but I was more conscious of making sure I breathed deeply enough. I assume that was a leftover from the anesthesia (propophol, fentanyl, and some other drugs I don't remember). 

Dr. C stopped in to let me know that my margins were clear (excellent news). Radiation treatments should start in about a month; fortunately, the center where they're held is only a few miles from me.

After M and I got home, we both collapsed into bed. Another way my fitness helps is that I can use my abs to lever myself up, since I need to be delicate with my left arm. I'll be taking it easy for a while, but in general my strength is returning very nicely.

(Above: Flowers from M's sister, plus the mug from my friend K.)

The Next Phase (copied from blog entry dated April 25, 2014)

Here's what's been happening in the almost-month since I last posted:

  1. I've gotten full flexibility back in my left arm (yay!) and was cleared a week ago to return to yard work (yay!). I've weed-whacked the yard for 3 hours, cut up brush for yard waste collection, and returned to planks about a week ago. I can't wrangle-cut the larger limbs as I could do prior to surgery, and I'm holding at 1-minute planks (versus 4 minutes for basic and 1:45 for sides prior to surgery), but I'm super-pleased at the healing I've done.

  2. I developed a seroma (fluid buildup) at my lymph node biopsy incision about a week after surgery, but that has now gone down -- which is great, because those things can stick around for a year or more. I felt pressure but no pain -- it was like walking around with a golf ball tucked under the skin near my underarm. I've got a similar situation by my tumor incision, but this is normal. My tumor incision still has surgical skin in place -- that healing is slow, but it is progressing.

  3. Three weeks or so after surgery I graduated to being able to get in and out of a T-shirt versus button-front shirts (yay!), and I can now get in and out of my sports bra without taking all sorts of extra steps.

  4. I did several freelance jobs. Three days after surgery I got back on my mini-bike, especially since my legs still work fine.

  5. I am almost completely caught up on dental work, which was way overdue. I didn't want anything to complicate my cancer treatment. The one remaining job is a crown (and a scepter!), but that will wait until after treatment. I had thought that the stress of all this was exacerbating my TMJ, but it turned out I had an abscess instead, so I'm very glad I got that taken care of.

  6. Here are the testing results so far: a grade 2 tumor with tumor markers normal, clear margins, no lymph node involvement, stage Ia cancer. However, we had expected and hoped that my genetic testing (Oncotype DX) would be low, and it is intermediate. Given my age, the oncologist recommended chemo. After doing a bunch of research and talking with people who are or who know cancer survivors, I have decided to go ahead with it.

On Monday I will undergo a MUGA scan to check out my heart, since congestive heart failure is a potential side effect of chemo. By all appearances my heart is fine (ECG was "rock solid normal"), but heart disease runs in my family and my mother died of it within 3 weeks of turning 57. I'm 55. I've lived a much healthier lifestyle than she had, but I figure you can't be too careful.

I am very, very thankful that I got myself back into fighting form before this all started, because my health and fitness are helping me now. I've read that exercise helps combat fatigue while under treatment.

M is holding up well with all this, though we've had our moments. Her background in biochemistry and immunology gives her a good intellectual cushion. She gets overwhelmed by other things, and I'm sure there are interplays among everything, but she hasn't been freaking out. I'd be lying if I said I wasn't apprehensive, especially after reading this guide to chemo (.pdf).

For me, the most important thing is knowing that I can concentrate on fighting cancer and not have to worry about holding my own against M. She is on board with this as much as she can be, which sets my mind at ease. For example, she made a major OCD concession to re-hook the washing machine up so that it drains outside as it was designed to do. She'd had this Rube Goldbergian set-up where she tried to drain it into a large plastic receptacle so that she could use gray water to flush the toilet. It all made a mess of the floor and then some, and I've taken loads to the Laundromat instead. I don't know what shape I'll be in while in treatment, and my bodily fluids are going to be toxic, so we don't want to futz around with washing. Also, my immune system is going to plummet.

I've been told to expect baldness, so I've gone ahead and ordered a couple of these from the American Cancer Society's TLC shop:

Though to be honest, the first thing that came to mind was trying to find a high-collared shirt like the one Persis Khambatta wore as Ilia in Star Trek: The Motion Picture, to show off the silhouette:

Then I realized that chemo will likely make my skin very sensitive (I'll also have to watch out for any cuts and scrapes) and I'll want to protect my head from the sun. The chemo caps have their seams covered to guard against irritation.

I'm trying to prepare in advance as well as I can, especially since I have no idea how I'll react to chemo. The range of experiences is tremendous. Once we get underway I'll be back in surgery to have a port put in. Chemo will take some months -- fewer or more, depending on how my body responds. Once I recover from that, it's then on to radiation for about six weeks and hormone-blocking meds for at least five years.

It's a challenge to be sure, but I am counting my blessings on several fronts.

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