The Year of Living Cancerously

I reunited with The Dutchman, this morning, to receive the results of last week's mammogram.  (Good thing the man doesn't have to take my pulse when I'm with him:  still so hot!)  It's a year ago tomorrow that I had the mammogram that kicked off this little adventure.  My results from last week:  all clear.

I'm scheduled for an MRI in April, so we can keep tabs on the left side, but there's nothing to worry about.  I'll see The Pill on September 7, so he can provide me with a fresh supply of Tamoxifen.  And The Burn wants me to pop by in March for a look see, but otherwise, my social calendar won't involve much Princess Margaret anymore.

I came, I saw, I kicked its ass.

Pancakes

Mammogram day, so pancakes for breakfast.

Among the less obvious benefits of being generously endowed is that mammograms don't hurt -- they're barely even uncomfortable.  But, I was a little apprehensive about how my right breast would feel during the squishitude.  Three surgeries might have made it a little... um... sensitive.  In the end, it made no difference at all.  Four images -- two on each side -- and I was out the door.

Next stop, a reunion with The Dutchman to learn the results.  Six more sleeps...

I'm Over It

My plan to win the lottery didn't turn out quite the way I'd hoped on Friday.  I won, but a free ticket, rather than a major cash prize.  So, I went back to work on Monday.

I was welcomed back by 450+ emails in my inbox, and a few colleagues in the hallways.  Unfortunately, my boss couldn't find the time to stop by and say hello.  Eight hours back, and it's like I've never been gone.

Heigh Ho, Heigh Ho...

It's back to work I go, on Monday. Ugh. Sayonara siestas; hello kitty withdrawal.

The top three reasons why having cancer beats going to work are:

• you don't have to wear a suit to have cancer
• no one tells you how they would have cancer
• no one jockeys to replace you, when you have cancer

I fully expect to struggle with returning to a regular routine, after being without one for a couple of months. Alarm clocks and bedtimes and torpor, oh my!

There are two more lottery draws before the new work week begins, and I'll spend this afternoon at the track, so there's still hope of avoidance. Baby needs a new retirement plan.

Brallelujah!

The underwires and the uplift have returned;  it's a beautiful thing.

A Month at Liberty

How odd:  I have 30 days ahead of me with no medical appointments.  That hasn't been true in a year.

The Burn is impressed with how quickly I am healing.  Frankly, I'm a little shocked by it.  So much for two weeks getting worse before I start to get better;  there's only a slightly-more-than-toonie sized patch of broken skin left on the tata in question.  By the end of the month, I should be back to smooth skin all over.  Granted, I'm not yet back to my usual fair tone, but that'll come.

With a date with The Dutchman in a month, and another with The Pusher in September, The Burn doesn't want to see me again until March next year.  How on earth will I keep myself entertained without someone with a white coat around to supervise?  Guess it's time to find out.

Wasn't That a Party?

It felt odd to get up, this morning, and not organize myself for a trip to PMH.  Not so odd that I couldn't reconcile myself to a 10AM nap, however.  Since I've never been able to stay up with the big people, I figured I'd better be as rested as possible for tonight's festivities.  So, I added another wee lie-down in the afternoon, for good measure.

The rest was much needed and well worth it.  More than 40 of the ass-kickingest people on the planet braved the heat, the lack of air conditioning (who knew?!) and the low-rent venue to wave goodbye to cancer treatment with me.  There were drinks and cupcakes and booby prizes and samples from the golden food group, but best of all there was much laughter and many, many hugs.

Except for one brief moment with a much-missed gal pal who called mid-evening, I managed to keep it together 'til I got home.  Then I opened the cards and read the personal notes penned on the t-shirt, and removed most of my mascara without using my hands.  I really am a lucky, lucky girl.

Like Dinner

Two words:  I'm done!

It won't make any difference to how I feel for a couple of weeks, but I can sleep in tomorrow, remove the EZ-Pass from my purse, take first aid supplies off the perpetual shopping list, and maybe start to get my life back.  One chapter closes;  another begins.

I thought they didn't want to let me go, this morning.  I think Dr. Murphy took over my case on the last day.  The bed set-up was wrong to start with;  we righted that after a while, and then one of the computers on my unit froze up halfway through my treatment.  Without the technicians' ability to control the accelerator, I was left in motionless limbo until the reboot was done and we could finish my zappage.  But, in the end, all was well, and they set me free.

Now, I get to look forward to Boobylicious and many left-handed hugs tomorrow.

One Hot Mess

Day one of the boost, and my blisters are weeping for joy that it'll soon be over.  There's no longer a comfortable position.  Even sleeping isn't restful anymore.  And I'm bored stiff with saline soaks and antiobiotic burn cream.  Deodorant is out of the question on the right side, and the only comfortable wardrobe choices are soft and loose -- more like pyjamas than anything else.  I dare not leave the house without ID;  if I'm struck by a car, I don't want to be identified in the news as a homeless person!

The boost treatments actually take longer to deliver than the regular kind.  That's 'cause the team comes into the room to spin the bed 90 degrees, halfway through the treatment.  It feels a little like being at Canada's Wonderland, if you don't count the fact that no one wants to go on the ride with me.  Still, I'm in and out in less than 15 minutes, which means that it'll be all finished in an hour.

Feelin' Hot-Hot-Hot!

42C outside;  third degree burns inside.  It's summer in the city, alright.

Tomorrow's my last full-breast treatment;  only five 'boost' treatments directly to the tumor bed will remain.  And the end can't come soon enough.  The Burn made the ouchy face when I revealed my brilliant red and blistered skin, this afternoon.  And the word is it'll be two weeks after my last appointment 'til my skin even starts to come around.

But, a week from tomorrow it's all over.  Time to prep for Boobylicious.  I feel a site inspection coming on!

Ow, Ow, Ooo, Ow

I had my 20th treatment today.  If the tatas were tinier, I'd be done now.  But I've got five more for the breast, and an additional five for the scar to go.  And I'm crisping up nicely.  What was pink is now red.  What was sensitive is now sore.  What was smooth is now broken.  The official word is "second degree burn".

Comfort is now defined as stillness.  If I don't move, I avoid the drag of skin against skin.  And it's way more comfortable to be braless than encumbered by lingerie;  as a result, except for trips to treatment, I'm trapped at home!

I feel something like a turkey.  Four times a day, I'm basting myself in saline solution, Lubriderm and -- new today -- burn ointment containing antibiotics.  Kinda curtails the social life, even without the relaxed dress code.  The Burn told me, today, that it'll take 10 days to two weeks for the inflamed skin to heal, once they're done frying me.  The countdown is well and truly on!

The Loneliness of the Long-distance Cancer Patient

Truthfully, at least in my case, there's no such thing.  Every day I have a treatment, I am reminded that I have more people in my corner than I have any right to.  The second half of the radiation rotation is full up -- and, unbelievably, I have a waiting list.

The team in Unit 10 is getting used to me having a new chaperone, each visit.  On the occasions when my date for the day is a man -- and, therefore, doesn't venture into the treatment room to see me topless -- the technicians always want to know whether I have a friend along.  I think it'd be as big a disappointment to them as it would be to me to venture in alone.

Starting today, the remaining play list looks like this:

The Communicator
Jockette*
Dollar Girl
Hollywood*
Marathon Girl*
The Free Agent*
Helmet-head
Miguel
My Fair Lady
The Source
G20
Dynamo
The Bride*
Skipper
Lucy's Aunt

* it's round two for these brave souls

The Frying Game

Apparently, pink is my colour, after all.  Halfway through treatment and I'm glowing like a beacon... or is that sizzling like bacon?!  The Burn says I'm about where I should expect to be, at this point, from which I take hea(r)t.

I swear my breast has had more attention in the last 10 months than it has in the previous 10 years.  These days, it's morning and night saline soaks followed by rubdowns with Lubriderm for Sensitive Skin (waterbased, don'tyaknow).  My left side is feeling distinctly envious.

Seems a shame to let all this radiant energy go to waste.  While I'm on leave from work, I might just explore the crime-fighting potential of my new alter ego:  Lobster Girl!

Boobylicious

I'm more than a third done.  Less than four weeks to go and radiation will be history.  So, it's not too soon to plan the party!  Invitations went out tonight.  If you didn't get one, and you're a regular reader of this odd little effort, don't be shy;  get in touch and tell me so.  I'll right the wrong and add you to the list.

Corks will be popped.  Fun will be had.  Cleavage will be displayed.

Support and Lack Thereof

I'm into week two -- today's treatment was my sixth -- and 20% of the way through treatment.

Today, I ditched the underwires.  Any pretense of perkiness is past.  I am now the less-than-proud owner of two industrial -- that is to say matronly -- bras the colour and texture of Tensor bandages.  Murphy's Law being what it is, I'll be wearing one of these hot numbers when I am rescued from my next traffic accident.  No dates with emergency health care professionals will ensue.

But though I am inadequately supported by what my Mum would call my foundation garments, my amazing posse of friends are lifting me up in all the right ways.  My daily treatments are turning out to be a series of delightful social engagements, rather than an ordeal to endure.  The schedule for the next eight days includes:

• The Free Agent
• The Yank
• The Mogul
• Jockette
• Flygirl
• Pecos
• Spinner
• The BFF

That'll see me halfway done, which seems remarkable.  And at the end of it all, perhaps I'll host a 70's-style bra burning!

Peggy Lee Was Here

Two down:  twenty-eight to go.

The experience of being radiated is about as stress-free as a cancer treatment could possibly be.  I check in by scanning my UPC-coded appointment card (hereafter, the EZ-pass), which indicates to the team that I am in the waiting room (and displays to me whether Unit 10 -- of the 18 treatment rooms, that one will be mine throughout -- is running on time), and sit.  But not for long;  I'm called within five minutes.

After changing into the ubiquitous gown (stripped from the waist up only), I'm accompanied directly to the Unit.  Right arm out of right sleeve, I lie down on the bed of the linear accelerator, with my head at the business end.  The bed is set up exactly as it was for my CT scan -- bolster at my hips, right arm supports above my right shoulder.  The team (two technicians and a student) call out and confirm coordinates, positioning me so that the tattoos and the laser beams all line up the way they should.  When everything's in place, they leave me.  It's only then that I notice music is playing -- agreeable, recognizable music, rather than the tinkly water-over-rocks nonsense:  it's not a spa, after all.

As they watch me on the monitors outside the Unit, the head of the accelerator (which is within a foot of me) rotates from its default position above me to a position to the right and below my right breast -- so the beam will shoot through the right side of my breast and avoid my rib cage and its contents.  A couple of clicks and a little whirring noise indicate that the apperture is open and positioned, and a few seconds of buzzing later, the head swings way over to the left -- the better to go at me from the other side.  The same noises repeat in sequence, then the "On the Air" sign clicks off, and the worker bees swarm in to undo all their careful positioning, only to do it all again tomorrow.

The gown reinstalled, it's off to the change room.  A flat twenty minutes after swiping my card, I'm back in the waiting room.  If that's all there is, my friend, then let's keep dancing.

The Radiation Rotation

Thank goodness I'm getting 30 treatments.  Any fewer and I wouldn't have enough to go 'round.  25 of my friends want to accompany me to an appointment, which means only five will have to pull double duty.  The calendar is still taking shape, but week one will feature:

• Trailblazer
• The Groom
• Showgirl
• Marathon Girl

Next week's schedule already includes:

• Hollywood
• Bella Cucina
• The Bride 

And more are being confirmed all the time.  How'd I get so stupid lucky?

Tats for Tits

I can add another variety of scan to my repertoire.  This morning, I underwent a CT scan, in preparation for my radiation treatment.  No claustophobia, this time;  it's like being fed head first into a doughnut, rather than a toilet roll.

The whole experience was mostly about positioning -- and being able to replicate that position exactly thirty more times in the next few weeks.  Lying on my back on a bed like a seesaw with my head higher than my feet, a bolster beneath my hips (so I didn't slide), my left arm at my side, and my right arm raised above my head, I'd have felt like a pin-up, if it wasn't for the hospital gown and the fluorescent lighting.  Once in place, the tape measures and the Sharpies came out.  Numbers were read out and keyed into the computer, and Xes marked the spots.

With everything confirmed, out came the blue ink and needles.  I always thought my first tattoo would come courtesy of a leather-clad guy with a shaved head and piercings.  Who knew it'd be a student therapist in hospital greens that'd do the job?  So now, where there used to be temporary black pen marks, there are permanent blue freckles.  But no anchors or hearts with "Mom" in the centre.

In the next few days, The Burn, a physicist and a radiation therapist will use the images from my scan to target the beams for the most effective treatment for me.  And starting June 1, we play connect the dots.

Tamoxifen Tuesday

I took the first of 1,826 Tamoxifen tablets, this morning.  Then I stood in the kitchen for a moment waiting for my first hot flash to begin.  Of course, it doesn't work like that.  Hot flashes are more like terrorism than war.  Ambushes by little hormonal insurgents, not an organized assault by ranks of uniformed warriors.  Let the Tamoxifen Taliban do its worst:  I'm ready.

No "Shit"

After so many meetings with The Dutchman, suddenly we've reached the end of the road.  I was checking in at YYZ when his assistant reached me.  The Tumour Board must be in league with the lingerie industry:  I can keep the knockers.  So, I was airborne about an hour earlier than scheduled.

Now the Tuesday CT scan and the June 1 date with the tanning bed are in pen, rather than pencil.  Not that my BlackBerry can tell the difference.

Collateral Damage

The downside of having kept my equilibrium through all the procedures thus far appears to be that the people to whom I report at work have completely forgotten what I told them before my first surgery in January:  "I will be away during treatment."  By behaving normally, I might have lulled them into a false sense of security.  Today, I dropped the bomb:  I'll be out of the office from June 1 to Labour Day.

Can I get a "shit"?  I thought I could.

Radiation: Hold, Please

The wait to see her was longer than my time with The Burn, this morning.  Though I had expected the full-on planning experience, it turns out that won't move ahead until The Dutchman reports back post-chat with the Tumor Board, next week.

So, we reviewed the potential side-effects and risks of treatment.   The big side-effects I already knew:  fatigue and reddening, dryness and itching of the skin in the treated area.  I didn't know that most patients experience dull aches or sharp shooting pains in the breast (kinda like lightning strikes, according to The Burn);  apparently, they're nothing to worry about... just part of the rich and colourful tapestry of cancer treatment.

The major risks are radiation pneumonitis (a lung reaction characterized by a dry cough, shortness of breath and fever three to nine months after completing treatment) and -- wait for it -- an increased risk of cancer (of the skin, muscle bone or lung in the radiated area) five or more years after treatment.  Ironic that a major treatment for cancer puts the patient at risk for more of the same, huh?

Good news, though;  I'm provisionally booked for the CT scan on May 18.  With that behind me, my first treatment day will be June 1, and I'll be off work for about three months.  Could make for an interesting version of "What I Did On My Summer Vacation".

When You've Gone as Far as You Can Go, You're Halfway There

The Dutchman told me today that I'm his second patient ever to undergo three lumpectomies;  less sweater meat and I would have had a mastectomy on round two.  I'm suspicious that he's simply warm for my form, but I'll give him the benefit of the clinical doubt.

Today's consult is brought to you by the letter E and the number 4.  E is for equivocal.  I might be finished surgery, or I might be back for a fourth round.  Not "shit" exactly, but certainly "crap".  The latest pathology report showed that the third excision uncovered more DCIS:  two focal areas a centimetre apart in the tissue adjacent to the last surgery site.  But in the section between that location and my chest wall, there were only normal cells.  So, the question is whether to move me along to radiation, or perform a lopatitoffame.

With the information I have -- an MRI that shows no further invasive cancer, a clean section behind the latest DCIS discovery, still only stage one cancer, and the knowledge that a regular screening mammogram is a solid early warning device -- and without professional advice to the contrary, I'll roll the dice and keep my rack a while longer.  But The Dutchman's by-the-book (just one of the many things I love about him), so it's back to the Tumor Board we go.  If his peers don't feel strongly that there are benefits to the mastectomy option, then I'm done with the knife;  if they do, the decision is ultimately mine to make.  Either way, I'll hear from the man after their May 13 meeting.

In the meantime, with The Dutchman's approval, I've confirmed my next appointment with The Burn.  On May 7, I'll undergo a CT scan and meet with her and the radiation team to map out my plan.  If I need to detour for another surgery before we get started on treatment, so be it.  But if not, I'll be more than ready to bust out the sun cream.  I'm sure I saw SPF 400 at Shoppers...

(G)Rad School

Booby school was three months ago, and now that I'm about to graduate from surgery to treatment, I feel as though I'm beginning my advanced degree in all things cancer.

It turns out ionizing -- or high energy -- radiation can be delivered alone or in combination with surgery or chemotherapy, and internal or external to the body.  I'll take the surgical/external combo platter, hold the chemo, please.  With a side of Tamoxifen (and a Diet Coke, natch).

Radiation damages a cell's chromosomes, preventing division and growth -- which is great for cancer cells, but not so sexy for normal ones.  So, the idea is to focus on the tumor, or tumor bed, if the tumor's been removed (...the tumors were nestled all snug in their beds...), and steer clear of the surrounding tissue.  The total dose is divided into fractions -- small daily doses -- in order to allow the healthy cells to recover and repair themselves during the course of treatment.  (My geeky heart was happy to learn that a unit of radiation is a "Gray", named for Louis Harold Gray, who invented the field of radiobiology.  100 units are a centiGray.  But I digress.)

Before my radiation plan can be finalized, I'll undergo a CT scan, which will allow the radiation team to see 'slices' of my body in the treatment area -- including my internal organs, as well as the boob in question.  The plan design is more complex than simply the number of treatments and the dates and duration over which they'll occur.  The radiation oncologist, therapist, nurse and physicist powwow about the number of beams they'll use, and the angles at which they'll direct them at my breast, in order to hit what they want to without also targetting my lungs, heart and spinal cord.  Only once they've sorted out the details will my 30 dates be confirmed.

The day I have my scan, I'll also be tattooed, so the technicians can position the beams in the same place each time I'm on the table.  Apparently, the tats are freckle-sized dots, applied by someone in a white coat.  So, the leather-clad, ponytailed biker inking in the kanji for "lopsided" turns out to be a pigment of my imagination.

Go For The Burn

So, I'm three for three on the cancer docs.  I met The Burn for the first time today, and we really clicked.  She's my radiation oncologist -- the chick in charge of my remaining treatment, once The Dutchman finally breaks it off with me.  Nothing we talked about, this morning, will firm up until The Dutchman says so, but I expect that my date with him on April 29 will be our last.  Assuming that's true, here's what else I can expect.

Thanx to the hefty hogans, I'm in for 30 radiation treatments.  That's 25 for the booby, and 5 for the scar.  (If I had a reduced rack, it would have been only 20.  Quel dommage.)  Radiation technicians apparently work bankers' hours, 'cause it'll be five consecutive days, with weekends off for good behaviour.  My rusty math says that's six weeks in treatment.

Once I'm officially done with surgery, I can start on the daily 20mg of Tamoxifen, as The Burn doesn't mind if I take it during treatment.  Bring on the hot flashes and the weight gain:  pseudo-menopause at its finest, unless I'm one of the lucky ones who doesn't experience those side effects.  Seriously, this is me:  what are the chances?

And only after The Dutchman signs me off can I schedule the beginning of 'rads' (listen to me, all down with the medical jargon).  But The Burn says between six and eight weeks post-surgery I need to be under the beams.  And I'm the girl who does what she's told -- at least by her doctors.  That's how I ended up here, remember?  The first appointment will be for a CT scan, and to design my treatment plan.  After that, we go live.

Looks like I'm guaranteed a sunburn, this summer.

Easy Peasy Lemon Squeezy

Surgery was so easy, the third time around, I could hardly stand it.  With no wires to install, no tracers to inject, and a surgery time of 3PM, the BFF and I weren't even required at the hospital 'til 1PM.  After that, it was check in, loll about in my room, try to ignore my rumbling stomach, and wait for the gurney that would take me downstairs.

I shared a room, this time, with a woman who was in for her first round of chemo after having surgery to remove a tumor in her neck, and part of her tongue.  Further evidence that I've gotten off lightly.

After autographing my right shoulder, as usual, The Dutchman told me Sunday's MRI revealed no surprises, so the surgery we discussed was the surgery I would have.  I'd been secretly concerned the MRI would somehow be a game-changer and I'd come out of OR with the bosom of a 9-year-old.  As it was, he spent about twice as long with me as expected -- surely he knew this would be his last chance to see me naked! -- but reported later to the BFF that everything went very well, and I'm going to be fine.

Was there ever any doubt?

Redemption

Elgar would be spinning like a top in his coffin, but "Land of Hope & Glory" was playing in my head as I strode, triumphant, from the MRI suite at Princess Margaret Hospital, this afternoon.  My regal pale blue cotton robes floated around me, and the booties-that-look-like-hair-nets softened my imperial step on the cold linoleum, but the effect was as magnificent as circumstances would allow.

2mg of Ativan, the BFF, and a delightful technician I'll name "Darling" got me smoothly through the IV installation, then into -- and 25 minutes later out of -- the trauma tube.  What a relief to have it behind me.  But what a kick to finally achieve what had felt so difficult on previous attempts.  And how proud I am to have been able to do, at last, what The Dutchman requires of me.  I do so want to be the pefect patient.

I hope I'll be able to learn the results, before I head into OR on Tuesday.  I'm quietly concerned that the images will show further areas of concern, and the course of my surgery may change.  But I'll burn that bridge when I cross it.  'Til then, I'm happy to have tucked another success into my medical folio.  Now where's that pink champagne?

He Just Can't Wait to See Me Again

'Yes' is my favourite word, and I got to say it again today.  The Dutchman's assistant let me know that there'd been a cancellation on the 13th, so she could move my surgery up two weeks.  I was rescheduling meetings before she could confirm the timing!

The BFF's on board, my agenda for next week has been cleared, and I'm ready to go.  All that's left is figure out what to do with the Sharpie on Tuesday morning.

Watch this space.

Gimme a "T"!

Mortification.  I forgot to shave!  I realized that two minutes before The Pusher walked into the exam room, this morning.  It's not like I didn't shower, or apply deodorant.  I just couldn't present him with the ne plus ultra of feminine underarms.  And on first meeting, too.  I was certain he'd be revolted.  Honestly, the stuff that goes through my head!

But, I got over it.  And, of course, The Pusher never said a word.

But he sure spouted a lot of numbers.  1.2 cm was the size of the largest site of invasive cancer The Dutchman removed (in the first surgery).  That makes me a T1C:  a tumor greater than 1 cm in diameter, but less than 2 cm.  My cancer is grade 1 -- so it can print the alphabet and knows its numbers up to 100.  There are four grades;  four is the nastiest, so I have a decidedly un-nasty kind (I believe "low grade" is the correct terminology).  I have a strong estrogen receptor positive expression, but only a 20% progesterone positive expression.  I showed no lymphovascular invasion (hence, the decision not to take further nodes in the next surgery).  And I'm HER-2 negative (the HER-2 protein is not causing my cancer):  woo hoo!

So, with a relatively small, low-grade tumor that's estrogen receptor positive in a HER-2 negative patient, the prescribed treatment is -- wait for it -- Tamoxifen.  And no chemo.  Officially.  It's The Pusher who would order that.  But he didn't.  Ahhhhhhhhhhhhhh.

It turns out only post-menopausal babes qualify for aromatase inhibitors;  so it's Tamoxifen for sure, and for five years.  Side effects?  Increased risk of uterine cancer and blood clots in the legs, leading to pulmonary embolism.  But the ones most likely to affect more women:  hot flashes and weight gain.  Why is it weight loss is never a side effect?!

Though I left with a 'scrip, it's actually the radiation oncologist who'll determine when I begin to take it.  Apparently, some of them prefer the patient to wait 'til radiation's concluded before they begin the drug therapy.  I'll get that news a week from Friday, when I meet with The Burn.

But one way or the other, I'm gonna be one hot mess in a matter of weeks.

The Brave One

The chairs in today's writing workshop all had labels on them.  We were asked to sit in the chair with the label that best represented us:  Seeker, Wild Card, Ms. Gloomy, etc.  Third to arrive, with two options claimed, I chose The Brave One.  Our last exercise for the day was to write about why we chose the chair we sat in.

* * * *

I only know how to have cancer one way.  That's because it's happening to me for the first time.

A screening mammogram in August resulted in a call-back in September and now -- seven months, three mammograms, four ultrasounds, three biopsies, two MRIs and two surgeries later -- I'm four weeks from my last surgery and ten from the start of radiation.

But it's my friends who think I'm the brave one.  I yam what I yam, as Popeye said.  This cancer business has been an inconvenience, and an occasional downer, but not -- at least for me -- a life-changing experience.

If I'm brave, it isn't breast cancer that made me that way.

As a kid, I moved halfway 'round the world with my family.  At 27, I quit my job and went back to school.  At 34, I divorced my abusive husband.  At 43, I made the biggest mistake of my professional life.

So, cancer?  Cancer's just the current canvas on which I paint the bravery I already have.

The Four Appointments of the Apocalypse

The Dutchman's assistant provided my next four appointment dates, this week.

First, a sign that my time with The Dutchman is nearly done:  a date with a medical oncologist to talk about Tamoxifen (or an aromatase inhibitor) on April 6.

Second, another attempt at an MRI on April 11.  I've got a prescription in hand for 3 mg of Atavan; we'll see if the extra two make a difference.

Third, a first appointment with a radiation oncologist (aka The Burn) on April 16.

Fourth, a date for my next (not yet "last", just in case) surgery:  April 27, with timing to be confirmed soon.

Not much of a social calendar, but a girl's gotta do what a girl's gotta do.

Third Time's a Charm

The BFF and I met with The Dutchman, this morning.  My pathology report was the only item on the agenda.  Well, that and a quick feel, of course.

Three weeks after surgery, both incisions are healing fine -- even with the slight inflamation of one end of the nodal wound (for which the GP gave me oral and topical antibiotics on Monday, both of which are doing the trick).

It turns out I'm two lymph nodes short of a full set, now.  The second one they removed showed no cancer cells.  The first revealed isolated tumor cells (ITCs) in tiny proportions -- .04 mm (that's 4 one-hundredths of a millimetre) at the largest point.  Taken together, that indicates a 5% chance of cancer appearing in the remaining lymph nodes over my lifetime.  A low number, and one I'm comfortable with.  And so is The Dutchman -- no further work to be done on that score.  And no chemo:  cue the happy dance!  Just Tamoxifen and radiation, down the road.

The additional breast tissue excised in order to clear the margins around the first lesion turned out to have further DCIS (precancerous cells) in its margin.  The Matrushka doll of lesions, as it were.  The new discovery is a 'skip lesion' -- a fresh area of concern, unrelated to the original site -- but now that it's been discovered, out it comes.  So, about a month from now, it's back on the table for round three.

If there was ever a time I've been grateful for big knockers, it's now.  Was I less generously endowed, a mastectomy would have been up for serious consideration.  But The Dutchman says he can remove the skip lesion and still leave me plenty of boobage, so I'll just be a little more lopsided than I am now.  Which is a little more lopsided than I was last month.  Which, in turn, is a little more lopsided than I was to start with.  I wonder if I'll list to port when all of this is over.

When No News Isn't Good News

I was pretty much psyched up for tomorrow's date with The Dutchman, but I'll hafta recalibrate the excitement meter.  The Dutchman's assistant e-mailed to say that there's a delay in pathology, and my report won't be ready for the morning.  So, my meeting's been rescheduled;  it'll be another week before I learn whether my lymph nodes are clear or cancerous, and what's to be done in either case.

More damned waiting.  Next week, it'll be seven months since my screening mammogram.

It's hard not to wonder whether the cause of the delay is related to the difficulty the pathologist had in analyzing the node sample during surgery.  But, PMH is a busy place, and it could simply be the volume of cases that's slowing things down.  Intellectually, I know there's no reason to jump to the conclusion that the news will be bad, but I'm tiring of the emotional roller coaster and I wanna get off the ride.

(Steri-)Strip Poker

As I dried myself, this morning, post-shower, the overlapping string of steri-strips fell away from the incision over my lymph nodes.  I pulled the few remaining sticky ends from my skin and looked a little hesitantly into the mirror.  Not too bad.

The incision is a couple of inches long, and conveniently located right where a bra's edge rubs against the skin below, and just forward of, the crease of my armpit.  The incision is slightly raised -- oddly, not sunken as the scar on the breast was, last go-round -- so the potential for irritation seems high.  I can recover the wound, though I'd prefer to go au naturel, if I can.

With the steri-strips off one incision, I'm keen to relinquish the uniboob fostered by the underwire-free sports bra I've worn 24/7 since Thursday, and reclaim my cleavage.  Time to break out the fire engine red number and take the girls for a spin!

Lymph Limbo

Back on my feet after a couple of days sleeping off the after-effects of anaesthesia, I'm still processing the post-surgical news.  Or lack thereof.

The Dutchman and the BFF pow-wowed while I was resurfacing in recovery on Thursday.  I seem to be a tough nut to crack in more than the obvious ways.  Remember the third biopsy?  The one they did 'cause they were looking for invasive cancer, but which didn't provide the evidence that turned out to be there, once I was on the table?  Well, it turns out my node sample proved just as inconclusive.  I seem to have a knack for the equivocal.

The Dutchman plays by the book -- yet again, my kinda guy -- so, when the pathologist reported that the sample was uncertain on first examination, he opted not to remove the nodes.  Don't take 'em if you can't be sure, he figured.  So, I left OR without a definitive verdict -- clean or cancer -- on the lymph nodes.  Which means it'll be the 18th before I'll know for sure what they found.  Or didn't.

And if there's cancer in the nodes -- you guessed it -- I'll be back for round three with The Dutchman.  So, twelve more days before I know whether the Gold Floor is behind me.  Hope for the best;  brace for the worst.

I'll practice saying "shit", just in case.

Three Close Shaves in 24 Hours

Checking in at Princess Margaret's Short Stay Unit is not like the Fairmont Gold experience.  Bypass the rabble in the lobby, and head straight for the penthouse.  Whip out your membership card, and the concierge confirms your reservation.  Luxuriate in the well-appointed club lounge until your private room becomes available.  If it wasn't for the lack of honour bar and the abundance of linoleum, you wouldn't know the difference!

This morning's check-in time was a very civilized 10:00. Unheralded for the BFF, we arrived early -- likely an indication of how keen I was to get on with it.  Or how little shampoo I require after my pre-surgery haircut saw me leave the salon, last night, looking like a baby seal.  Between that and the freshly shaved 'pits, I feel virtually bald from the waist up!

Right on time, the BFF and I were escorted across the bridge to Mount Sinai and the nuclear medicine department.  Yes, nuclear medicine as in those yellow tricorn signs reminiscent of The Simpson's.  Homer's younger, smarter sister ushered me into the business end of the facility, where I came face to face with a scanner that looked way too much like an MRI for my liking.  But, on closer investigation, it featured a shorter tube and an open side, and turned out not to be in any way scary.

My notes from Booby School reminded me that the injection of the tracer for the sentinel node scan would sting, but I lucked out, bigtime.  It turns out that the upside of having lost sensation in my right breast is that I didn't even feel the two(! -- I swear they never talked about two!) injections next to my nipple.  Thirty minutes on the scanning bed -- no, not the tanning bed;  I'm still as pale as ever -- and the tracer had done its work and highlighted my sentinel node as  a pale white dot on the green computer screen.  With an X to mark the spot, we headed back to the PMH penthouse to await my date with The Dutchman.

On returning to the Gold Lounge, we were escorted to the Presidential Suite -- er, Room 206 -- a private room featuring a lake view, an ensuite, a wet bar and a handy call button for my butler. No room service menu was in evidence, however, and I still haven't found the spa; I must remember to complete a comment card when I'm next in the building.

Again on time, my ride appeared to take me to surgery, pimped out with toasty warm blankets and institutional green linens.  It was oddly relaxing to discover that the same Grim Sleeper was on duty, though the rest of my surgical entourage -- or are they The Dutchman's? -- were all new to me.  It wouldn't be my surgery without a little Sharpie action, so when the man himself showed up, it was time for the big reveal.

The rest of the afternoon ticked away without my knowledge;  two hours later, I was back in recovery, but this time with no mambo heartbeat.  It wasn't long before I headed back upstairs to reunite with the BFF... without a drain, and with all but a thin slice of my lymph nodes intact.

A little apple juice, a few laps around the Gold Floor and some time in the ensuite, and it's off home.  Just another day in Cancerland.

Movin' On Up

The Dutchman’s assistant surprised me, this afternoon, with an opportunity to advance my surgery date by almost two weeks.  After a quick call to ensure the BFF was onside, I jumped at the chance.  Suddenly, I’m less than a week away and scrambling to get organized.  It’s going to be a busy weekend.  There’s laundry to be done, the larder to be stocked, a kettle to be purchased (the BFF shouldn’t hafta make tea in a saucepan!), and a few projects to get a jump on at the office.

The agenda for March 4 is rather civilized: a 10AM check-in, 12 noon for the dye needle, and 2PM under the knife.  Barring delays, I should be home in time for the 6:00 news.  And out like a light by 7!

The best news about the shift is that by moving the surgery up, everything else moves up with it.  The pathology meeting will now be March 18, with whatever treatment follows sooner, too.  As they say in the west, pitter patter, let’s get at ‘er.

Rocked... and Rolling

The day I turned 11, my best friend moved to Vancouver.  I had planned to go to the airport to say goodbye, but my parents had other ideas – in the shape of a surprise party.  So, I played nice with the neighbourhood kids while Janet flew away, never to be seen again.  I’ve never liked surprises since.

So, when The Dutchman ambushed me with news of invasive cancer, a week ago, it set me back on my heels for a few days.  When diagnosed with DCIS in December, I wasn't surprised;  I'd undergone a battery of tests, each one leading me to a more certain knowledge of what I had.  But, on Thursday, I heard news I hadn't been led to expect.  Now I understand a little about what my friends and family felt when I dropped the bomb on them, in January.  Payback's a bitch.

But, a week later, The Dutchman’s assistant e-mailed the date for round two, today.  I’ll be back on the table on March 16 – seven weeks after first go-round.  My post-surgical meeting to review the next pathology report?  April Fool’s!

A little perspective is a wonderful thing.  I’m pleased to have a new date in hand, glad it’s far enough away that I can squeeze in a visit to Dad beforehand, and keen to get on with it.  And that’s how we roll, in 2010.

Date for a Do-over

The Dutchman can't keep his hands off me.  At today's pathology meeting, he told me that the 7+ cm lesion he removed included a small area (1.2 cm) of invasive cancer.  It's stage one, so still a low score on the scareometer.  But it means he wants to go back for more tissue and -- totally ugh -- a sentinel node biopsy -- with an axillary node dissection, if pathology while I'm on the table shows malignant cells in the node.  Shit.

So that 'cancer light' nonsense I've been so smug about is history;  it appears I'm dealing with the real thing. Did I say "shit" already?

Surgery will take place in another four weeks or so (there goes IADB in Cancun), followed by radiation six weeks after that (bye bye ADB in Uzbekistan) -- or worse (arividerchi Central Bank in Rome).  Oh, and a node dissection would mean I'd come home with a drain, this time.  Surely I haven't said "shit" yet.

On the upside, this surgery won't include wires (though I will get the bee sting of injectable dye), I'll get more time off work without using any vacation days, and I'll get to spend more time with the BFF.  Not so bad, after all.

The Full Feel in the Nation's Capital

Twelve days post-surgery and I've just been felt up. It was painless.

In Ottawa for the afternoon, I hit the extra-screening jackpot going through security.  Welcome to post-exploding-underpants travel.  After not setting off the detector alarm -- phew, I thought, dodged the magic wand and pat-down! -- I was pulled aside for a second screening.  As the naked scanners are backordered at Sears, it's the everything-short-of-a-cavity-search treatment for me.  No hot guys, this go-round; it's all about the twenty-something woman in ill-fitting navy polyester.

Canadian pat-downs are certainly more thorough than they used to be (though still less thorough than the American version).  I imagine those in-the-security-know believe it's more impersonal to feel the back of a hand on one's tits and ass than a palm, but it's all the same to me.  So round, so firm, so fully packed.  She blessed my boarding pass and I was gone, steri-strips and dignity largely intact.

Frankenboob: The Unveiling

There's a reason I don't go camping:  the lack of hot, daily showers.  Climbing under the spray, this morning, was like having an extra birthday.  I am now the cleanest girl in town.

Given my melodramatic behaviour of earlier in the week, I was nervous about removing the dressing from my incision, this morning.  So much so that I didn't get into the shower until 9:30 -- a good couple of hours after I got out of bed.  And I didn't begin to peel the sticking plaster until the water was running over the gauze.  But the news is all good.

I'm a little bruised and, from what I can see under the railroad ties of the steri-strips (and I'm not all that curious), the incision is about 4" long.  But there are no bolts protruding anywhere, no large black stitches evident, and still -- remarkably -- no pain.  I've already decided that my witty rejoinder, when asked by future lovers what the scar resulted from, will be 'I cut myself shaving'.

I'll still hafta stay off the breast for another few days, but the healing has begun in earnest.

Here, Not There

Before hitting the road for PMH, the BFF and I had a little fun with a Sharpie.  I want Team Ta-ta in a good mood, today!

We arrived right on time at 7AM, which is ugh-worthy on an average day, much less the day of surgery.  I had expected to sleep badly, but woke up with the nose hose in place, and feeling rested.  It was a busy day on the Short Stay Unit, so there was no room at the inn.  We decamped to the visitors’ waiting room and unpacked the BlackBerrys.  A couple of working girls on a tear.

At 9AM, we relocated to the third floor. The BFF was summarily hauled into a separate waiting room, and I cooled my heels within shouting distance – but not sight – of her.  I refrained from shouting.  Nearly an hour later, still in the same hallway, it was revealed that my imaging (i.e. original mammogram films) were nowhere to be found, and they ushered me in for a fresh mamwich.  Now things were moving, if only slowly.

Over the course of the next two hours, I had three wires installed:  one under mammography, a second – and, unexpectedly, third – under ultrasound.  It turns out I would have been a standout in Victorian England:  I swoon with the best of them.  Hence, the need to be prone after the first wire went in.  Number two was perfectly positioned – and then didn’t deploy properly.  So, we went for three.  By the time I got outta the breast imaging department, I looked like a high tech porcupine.

Back upstairs, there was still no available room, so we hunkered down again in the visitors’ lounge.  1PM comes and goes.  1:30 comes and goes.  When does my gurney arrive?  Two o’clock comes, goes.  Three.  Finally, someone checks out of the hotel PMH, and a room comes available.  At almost 4PM, it’s go time.

Off to the surgical suite, where things move quickly.  IVs are installed, the Grim Sleeper and The Dutchman come by, admire Rita’s handwriting, and I’m transferred to the OR.  Five minutes later – as far as I know – it’s 5:10, and there’s a mambo rhythm beeping from the monitor above my head.  I’m awake, the surgery was successful, and I have “extra beats”.  Heart beats.  In my drug-addled state, more seems better than fewer, but they need to check that out.  So, I get a 12-lead ECG, which I apparently pass, as I’m released back upstairs for the final time, but not before snagging a couple of jumped-up Tylenol 3s for the road.

It’s 6PM, and I can’t go home until I’ve been to the bathroom without help, and had a little nosh and kept it down.  Truly, the bar is set at the three-year-old level!  I’m so hungry I could eat furniture, but, oddly, nothing on the hospital tray is appetizing, except a pear and a container of what appears to be grape Koolaid.  So, I knock those back, drink a half-litre of water and wait.

And the angels sang.

The sports bra goes on, the departing paperwork is delivered, and I’m off home with the BFF.  It’s nearly nine o’clock.  Five months after the screening mammogram, phase one is over.

PTSD: Post Tit Surgery Dispatch

A hot guy spent an hour with my naked breasts in his hands, this afternoon -- and I was unconscious the whole time!

I'm vertical, but not for long.  I'm a model patient -- which, unfortunately, does not mean my weight is a two-digit number -- and The Dutchman said only positive things in recovery.  Though I was dopey (or perhaps it was sleepy or bashful...) at the time, I do recall he said surgery went very well, they 'got it all', and I'm sure there was something about alabaster skin and limpid eyes.

The BFF is bundling me off to bed (there's a reason she's a mother and I'm not).  I'll file a more detailed report when I can access more than 10 of my brain cells.

One More Sleep

I’m having a sleepover – and not my usual kind. This time, the guest will still be here for breakfast! So, today, I stocked up the larder. It’s been a point of pride for me to be able to see the back of my fridge at all times. The running gag revolves around a reliable supply of yellow mustard and Diet Coke, and not much else. But, if the BFF is supposed to care for me, I need to care for her.

As a result, I now own cereal, milk, tea and yogurt... most of which are cramping the Diet Coke’s style.  The laundry is done, the DVDs have been rented, and I'm as ready as I can be.

Bring it on.

Perspective You Can't Learn in Art Class

In case I wasn't already convinced I'd gotten of easily, today's pre-surgery class confirmed everything I'd suspected.

There were 11 of us in booby school, this morning, all having surgery for breast cancer within the next two weeks.  Just a couple of us were having the wire-guided procedure;  the rest were having some combination of lumpectomy or mastectomy with serial or axial node biopsy.  At least one woman was scheduled for a double mastectomy.  By comparison, I might as well be having a manicure on Tuesday!

So, here's what I can expect to happen.  My surgery will be at Princess Margaret Hospital.  When I'm admitted, I'll be checked into my own room -- mine for the day -- which will be home base for me and my BFF.  Nothing to eat after Monday midnight, and nothing to drink after 7AM.  Apparently, there's no room service at the hotel PMH;  so, not a 5-star, then.

They'll wire me up at 9AM, then return me to my room.  (I've convinced myself the wires will be as fine as those used in accupuncture, rather than straightened out coat hanger ends;  I hope I'm right.)  Surgery's at 2PM.  An hour in the OR, 30 to 45 minutes in recovery, and I'll be back to the room again.  Once I prove myself fit -- one-handed pushups?  an IQ test? -- they'll spring me, and it's off home about dinner time.

I might get morphine after surgery, so if I end up in a 12-step program down the road, I'll know where it all began.  I'll have self-dissolving stitches and a dressing over the incision -- the low maintenance approach to healing.  No nasty clips or staples or stitches that have to be taken out with garden shears.  And, with luck, the gauze will compensate for the dent.

The nurse assured me I'll be leading a normal life again within a couple of days.  I've never led 'a normal life', so I'm a little concerned that a large van will show up on Thursday and leave me with two sullen teenagers, an aging labrador retriever, an SUV, and a balding, slightly pot-bellied man, who claims to be my husband.  Perhaps I should start screening my calls.

Booby School

I’m just over a week away from surgery, but before they’ll let me into the OR, I have to go to Booby School on Tuesday.  Well, of course it's only me who calls it that – and I don’t have to go.  (But I was a Girl Guide; I want to Be Prepared.)  Officially, it's Breast Surgery Preparation Class, or something equally forgettable, but Booby School sounds like so much more fun.

I’ll have to attend unaccompanied, as there’s a patient confidentiality concern.  I guess not everyone subscribes to the ‘seen ten, seen ‘em all’ philosophy I’ve so long espoused.  Oh, well.  I was never one to crib off my neighbour’s work, and I’m still hopeful of an A – or do they choose the valedictorian based on bra size?  Either way, I’m a contendah!

The curriculum remains a mystery, or I’d read up in advance, but I’ll get to meet with a social worker (presumably so I play nice with my surgical team), a dietician (is it gauche to imagine that dairy is the most breast-friendly food group?), a physiotherapist (we must, we must, we must…), and a nurse (finally, someone who’ll talk about surgery).

I wonder whether there’ll be two tassels each at graduation.

I Don’t Want To: I Have Cancer

This morning, I played the cancer card for the first time.  And I didn’t think twice.

Someone I’ve never met, who’s looking for a planning job, e-mailed me to request an interest interview.  I’ve done dozens of these in my professional life, and this is the first time I recall having said no.  I’ve always given my time to industry newbies in recognition of the fact that I was one once – back when the dinosaurs roamed the earth – and back then, there were experienced people who were kind to me.  But, I found this woman annoying.  She’s a friend of a person I’ve met twice, for whom I opened a door that landed him a job – and now I feel pressured to find one for her.  That’s not how the process is supposed to work.

So, when I read her ‘tell me when you can meet with me’ e-mail, it took all of 30 seconds to respond.  ‘I’m sorry to tell you that the timing’s not good.  You see, I have cancer....’  I was direct – but not tactless – and I got what I wanted.  I offered advice, wished her success in her search, and got away clean.  I’m not used to putting myself first, or saying no; I just think I should for a while.

But what if I learn to like it?

How Do You Spell Relief?

Relief is not spelled R-O-L-A-I-D-S, as those of a certain age would naturally reply.  This morning, relief was spelled L-U-M-P-E-C-T-O-M-Y.

My date with the Dutchman answered some pressing questions, notably:

• biopsy three told us nothing we didn’t already know – i.e. I don’t have an invasive flavour of cancer – so, I get to skip the sentinel node biopsy, chemo and (best of all) another attempt at an MRI
• Mum’s breast cancer has no bearing on my own condition, so I get to skip genetic testing for the BRAC-1 and -2 business
• mastectomy is too aggressive for the cancer I have (yep, I asked the tough question), so I get to keep the booby

I fairly skipped out of the hospital.  Knowing exactly what I have, and how we’re going to deal with it, makes the planner in me very happy.  It lets me make checklists and critical paths, and exercise my control freak muscles.

This afternoon, relief was spelled P-U-B-L-I-C.  The emotional strain of keeping secrets is over, at long last.  (Except for Dad. I still won’t tell him ‘til after surgery.)  Now I can plan my next appointments, organize my winter work schedule, and take phone calls without having to speak in code.  It turns out, I wasn’t cut out to be James Bond.

0 for 2

Princess Margaret Hospital has a newer MRI machine than Mount Sinai.  It's a larger 'bore', or diameter, so I was hopeful that I would tolerate the 'in the tube' business better, this afternoon.

For all the larger bore might have helped, here's what didn't.  They fed me into the maw of the beast head first (as opposed to feet first nextdoor at Sinai).  My arms were held at my sides (rather than extended overhead in a diving posture nextdoor), and strapped down across my back.

So, fed into the machine, face down, head first, my arms felt wedged against the inside of the chamber. Not only could I not stick 30 minutes out -- I couldn't even get started.

And the sedative? Please. The Dutchman must have prescribed for someone who weighs 100 pounds. I took the pill at the appropriate time, and never felt anything kick in. I could definitely have operated heavy machinery afterwards!

So, if he wants another one, the man's going to have to knock me out.  Guess I'll find out on Thursday.