So Many Appointments (Again)

I am in appointment season; ending one treatment phase (chemo), entering the next (surgery), and planning for the last (radiation).
Since my final chemo on March 8th, I have had one follow up with the Nurse Practitioner (just a check-in to see how I was doing).
John and I met with the breast surgeon on Friday for my pre-op appointment, which included another ultrasound of the right breast, where the tumor was, and of the lymph nodes under that arm (which now show no cancer activity as well!). Dr. V. says that he expects that my post-surgery pathology report (this will provide the most accurate information about my cancer status since my biopsies and scans last fall) to show either near-complete (98-99%) or complete (100%) pathological response. YAAAAAASSSSSSSS
Additionally, he stated that this means that my prognosis is at 90% of never having a recurrence. This, my friends, is the gold here, and I will admit to feeling skeptical, a little afraid to believe that could be true for someone with TNBC. Don't get me wrong, I am extremely happy to hear this, but I am also going to ask my medical oncologist for her opinion. One thing I have come to learn is that different doctors have different takes on how they discuss cancer, for example if they use the word, "cure," or whatever. I tend to view my medical oncologist as more of a "cautiously optimistic" type, and my breast surgeon is definitely more... emotive.
Dr. V. also discussed his thoughts on how many lymph nodes he will take (something he won't know for sure until we are in surgery). He wants to be sure to take what is needed, but not to take too much. He thinks maybe 3-4, but to be certain he will first inject me with dye and radiation (sentinel lymph node biopsy) that will highlight any active cancer. I am hoping for this low number, because the more you take out, the higher the likely is for developing lymphedema (swelling and/or cording in the arms where lymph nodes were removed). I do not want lymphedema. The nurse navigator, M., also met with us to book my first physical therapy appointment and EKG that will need to happen prior to surgery.
In the meantime, Dr. V. wants me to practice calming exercises such as meditation, breathing exercises, and chest-openers to help with my posture.

Next we attended a breast surgery pre-op class, where John was congratulated for attending and for taking notes (he should get tons of credit for being a great partner! And this also weirds him out a little). We learned about:
Pre-Surgery Prep

• Move oft-used items on high shelves to low shelves (I will have limited range of motion for a bit, aka T-Rex arms);
• House cleaning;
• Meal prep ("This is not the time to say no to people who offer to bring you meals");
• Remove tripping hazards;
• Stock up on additional pillows for propping up in bed (I will need to sleep only on my back for a bit);
• Purchase mastectomy bras (I didn't know what these were, either. Basically a super-soft front-zip sports bra with lots of ways to adjust to accommodate swelling and bandages-- OR you can go the high fashion route with AnaOno or Stella McCartney);
• Dr. V. suggested that since I am going to attempt to avoid opioids for pain management, I should take cold showers for the 5 days leading up to surgery (ugh).

What Happens in Surgery

• The breast surgeon will perform surgery first, and then the plastic surgeon will take over for reconstruction;
• Will last 3-4 hours (and I will have to stay overnight one night);
• The goal is to remove all of the identifiable breast tissue; 
• I am having what is termed a "total or simple" mastectomy; 
• Not sure yet if I will have direct-to-implant or expanders (will know more at plastic surgeon pre-op appointment on 3/29). 

Post-Surgery

• Bland foods are ideal for the first few days (le sigh);
• Hydrate, hydrate, hydrate!;
• I will have at least 2 drain bulbs (look like clear plastic grenade attached to tubing that will be the means for draining extra fluid from the mastectomy site and yes this sounds gross but we deal, do we not?!), and they gave me a drain belt, which is a definite fashion statement;
• Must empty drains and record amounts;
• No heavy lifting for 4-6 weeks;
• Must do daily PT exercises; 
• Take it easy but stay active; 
• Complementary pain management (distraction, relaxation, progressive muscle relaxation);
• Drains removed when fluid output becomes consistently minimal;
• We should receive the pathology results within a week;
• Follow up with breast surgeon at 6 months.

After Treatment

• Reducing risk of recurrence:
• Maintain healthy weight (includes limiting animal-based products);
• Limit alcohol intake; 
• Adopt a physically active lifestyle;
• Smoking cessation.  

NEXT UP:

• Radiation oncologist consult;
• Medical oncologist post-chemo/pre-surgery check-in; 
• Plastic surgery pre-op;
• 30-Day post-chemo labs and appointment with Nurse Practitioner; 
• Pre-surgery phone call with a nurse; 
• Physical Therapy initial appointment;
• EKG. 

My mom will be coming out for the surgery and to help me out for a few days afterward. Thanks, Mom! 

So now you know what I am up to (aside from list-making). Very lucky to have contract/work-from-home flexibility during this time, and for the flexibility John has had with his schedule so he can attend some of these appointments with me. It is true that having someone with you to help absorb all of the information is a wise and good thing. 

How Are You? Just Fine, Thanks!

How are you?
There is so much to this question for me-- obviously now, but I have actually always struggled with this greeting.
I don't really know why. I think I have always been a self-reflector (one who self-reflects?), so the question, to me, reads deeper than it should.
I want to tell you of all the assorted ways that I feel, of how I am truly doing. I have learned to embrace this awkwardness about me, but it took a long time to successfully supply the rote and expected response of, "Great, thanks! How are you?"
I do not attribute any sort of callousness to this greeting, though I think there are better ones out there, ones that won't cause people like me (over-thinkers?) to pause, mentally review their life story in its current iteration, and then blather on about how I take the dog, Toby, for walks daily unless it is too cold or possibly rainy, which it has indeed been, and then a barrage of medical updates, also I like when I see this white deer on my walks, oh and I am definitely terrified of catching the flu this season, and I have been watching the show "Riverdale" and it is actually not that bad!, I have had some contract work so that's super cool, oh and also I am rereading A Wrinkle in Time before it hits the theaters... etc. So you get the point, yeah? More odd is that I am not otherwise an over-sharer.
So that was a really long way to get to an update about how I am doing. I am fine, thanks! How are you?

I have two chemo infusions left, scheduled for February 16th and March 7th. This new chemo (adriamycin & cytoxan) is a great deal suckier for me than the previous stuff (taxol & carboplatin). I may not have shared with you already that there is a nickname for adriamycin... the Red Devil. Named so for its color (yep, it really is red) and for the toll it takes on patients. Also because it must be administered very carefully so as not to damage skin or veins-- my nurse actually sits and pushes the red devil in via giant syringe. YEAH. It takes about five minutes total which makes me think of the phrase, "A moment on the lips, a lifetime on the hips," but reimagined as, "A moment in the port, a week on the couch." And a lifetime of no more cancer, right?
Thankfully there are meds to counteract the nausea, which is helpful-- but really what it means for me is major food aversion. Everything sounds disgusting for at least a week. Some advice I received from someone in the Young Survivors Coalition (this is an org for people who have had a breast cancer diagnosis while they were young) was that when the brain and the stomach agree on a food, you eat it. This has resulted in some interesting dinners, such as tater tots (just tater tots, nothing else), just fruit or fruit snacks, just a sweet potato. I have even had some meat, just because it did not repulse me. So we will get through this next month and reconfigure the food situation once more.
For my next infusion, I have called in reinforcements: my mom is coming to visit again!

One more update that I am even less happy to report is that I had to spend a couple nights in the hospital last week for neutropenic fever. LE SIGH. Please do not worry, because it was not something serious. But it could have been, so they keep you for a few days, no matter what. Like cancer jail.
A neutropenic fever means low neutrophils plus a fever. Very low neuts, as they were at .2. My fever was low grade (100.6 at its highest), but they tell you to come in if it is above 100.4. I first called the on-call oncologist, who said to take a Tylenol (you are not supposed to do this unless explicitly told-- they do not want you to mask a fever), go to sleep, and if it spikes again in the night, to come in. It did and we did, at 3:00am (NATCH, because who goes to the ER at a normal hour?). Long story short, they transported me to the hospital, gave me strong antibiotics, and observed the hell out of me. After many a test, they could not find the source of my fever, and really it could just have been my own regular bacteria causing it since my immune system was compromised. My fever went down and stayed down right away, and once my neuts got back up to a safer level (1.4), they let me go. I disliked this entire experience, but was super grateful for John staying the night each night, and for the amazing medical personnel at every step of the way.
Side note: Who are these people with these insane jobs? They work ridiculously long hours and see some horrifying sh&* and I just do not understand it. My EMT works 24 hour shifts! And still volunteers as a volunteer firefighter/EMT on the side! Just... no. But thank you, thank you, thank you, to those who do this work.

Tomorrow I have my first appointment with my plastic surgeon.

Cool story, Hansel.

I asked for a sweet potato, and I got a sweet potato. Thanks, John!

I can relate.