And Tuesday.  And Wednesday.

Monday and Tuesday were two totally crazy, emotional roller coaster days.  On Monday, I went to Seattle Cancer Care Alliance to meet with my surgical oncologist, Dr. Sara Javid, to discuss her portion of my surgery – the bilateral mastectomy.  Dr. Javid has a great bedside manner.  She’s very petite (and pretty), and she comes across as a neatly packaged powerhouse of kindhearted genius.  This appointment consisted of reviewing my medical and family history with Dr. Javid’s surgical resident, her answering my litany of questions regarding the surgery, and a talk about the mastectomy itself.  I will not go into the list of questions I asked Dr. Javid (or the P.A. I saw at the UWMC); I will post them separately.  The things that I feel were most important to me were:  a) how they would screen my breast tissue once it was removed (and when we would get results), b) what would happen if there was early cancer found in the breast tissue, and c) what part of the mastectomy would cause me the most post operative pain.

Dr. Javid explained that once all of my breast tissue was removed, it would be sent offsite for pathology.  The pathologist would then take multiple slices of the breast tissue, view them under a microscope, and look for cancer cells.  I can expect my pathology results within 6 to 10 business days.  If there are any signs of early cancer, then Dr. Javid and I need to meet again to discuss and schedule axillary dissection and removal of my lymph nodes.  I wouldn’t be able to have the sentinel node biopsies, like women who have not yet undergone the mastectomy, because the dye that is used for that screening is rendered ineffective after mastectomy.  So my lymph nodes would have to be removed and screened in pathology.  Whatever the results yielded would dictate my treatment plan from that point forward.

Dr. Javid said she believed the most postoperative pain related to the mastectomy was the tissue removal from on top of the pectoral muscles.  Since her goal is to remove the breast tissue as completely as possible, and reduce my risk as much as possible, she will basically scrape breast tissue from my muscles.  Yummy, right?  Other than that, the majority of my pain will relate to the reconstruction (because my nerves in my breasts are being removed with the tissue).  The J.P. drains are a well-known foe to post surgical comfort.  I’m sure you could go through innumerable blogs similar to mine and find an ark full of complaints about the discomfort of the drains, the stitches that hold them in, and the seemingly never ending, immeasurable length of the drain tubes inside the body.  I think in my recovery posts I shall refer to them as “ye old dreaded drains” (or maybe just “dreaded drains” in the interest of brevity).

After that, Dr. Javid and I briefly reviewed the potential incisions for the skin sparing mastectomy, and she also double checked with me that I was positive that I do not want the nipple sparing mastectomy (and I still don’t!).

——–

I was truly disappointed to find out at my appointment that I wasn’t meeting with the surgeon performing my DIEP reconstruction (Dr. Louie), but was instead meeting with his P.A., Jennifer Flannery.  I don’t mean to come across as I need to see THE surgeon himself or no physician at all – it just would’ve been nice to be told in advance that I wasn’t seeing my surgeon.  Why?  I don’t know, exactly.  Maybe it’s because I’m looking for any and every familiarity and comfort in this situation; maybe because consistency is really convincing; or, maybe because I’m freaking the hell out that the countdown is on and this is a very big deal to me.

After the requisite introductions and preliminary questions, I had a brief physical and then started in with my questions about the DIEP flap reconstruction.  I was surprised that in this meeting was the first time I was told that if the blood vessels (the “deep inferior epigastric perforators”) were awkwardly situated or too difficult to retrieve without removing part of my abdominal muscle, then the surgeon would go ahead and remove a small portion of my muscle in order to retrieve the blood vessels.

This is why it is a good thing to be hyper vigilant and semi-neurotic (full blown neurosis gets your surgery cancelled) about researching your surgery.  In all of the other blog posts, videos, forum discussions I’ve come across during my personal research and preparation, I hadn’t read that this was a possibility.  So while the purpose of the DIEP flap reconstruction is to keep the abdominal muscles intact, it is still a possibility that a portion of the muscle has to be removed.  This, obviously, would impact recovery time and the integrity of the abdominal wall.  Bummers.  Something else that I was unaware of:  the surgeons will have to drill small holes in my ribs to connect the DIEP vessels to the blood vessels in my chest.  Jennifer told me that the holes were not of significant size to worry about the integrity of the ribs themselves, but this part of the procedure does cause an increase in post surgical pain in the chest.  According to Jennifer, the majority of my pain will come from the hip-to-hip incision made on my abdomen for the fatty tissue and DIEP flap.  There will also be discomfort when trying to stand straight up, which may take some time to do.  The other bummers:

  1. There is no quick road to recovery.  I’ll be down for at least 2 weeks, very likely 4 weeks, but should plan on 8 weeks of completely depending on other people for help “just in case”.
  2. I won’t be able to pick up anything weighing more than 5 lbs for at least 4 weeks.  My daughters each weigh at least 26lbs.  My cat weighs 8 lbs.  My hand, where my middle finger resides, thankfully weighs less than 5 lbs.
  3. I have to be medically cleared for any exercise other than walking.  Running, jumping, cycling, weight lifting, plyometrics, punching people in the face…all off the table for at least 3 months.

Also a surprise:  I didn’t know until poking around on the Internet today (the day after my meeting at the reconstructive surgeon’s office) that Jennifer Flannery handles the areolar tattooing after nipple reconstruction.  I assumed that Dr. Louie didn’t do it, but I didn’t know that Jennifer was the lady in charge of this part of the reconstruction.  Had I known, I would’ve hit her with all of my questions regarding that “little” procedure.  Like:

  1. How best to get a pigment match for my areolar tattoos?
  2. How is my pigment determined and matched for the areolas?
  3. How frequently will I need to have the tattoos touched up?
  4. Exactly what color(s) do you think make up a Buttery Nipple?
  5. Do you lean more towards the quarter or the silver dollar?
  6. Do you want to take pictures of my natural breasts and pigment for a match and comparison?
  7. Are you sure you don’t want to take reference pictures?
  8. How about if I take reference pictures and bring them to you?
  9. What amount is a good amount of reference pictures of my natural breasts?
  10. Are you sure?  Are you sureARE YOU SURE?!?

I would also like to note that I have made some really fantastic strides in my strength, health, and fitness these past six months with my trainer, PDiddy a/k/a Paulie Walnuts, a/k/a Pauly Shore, a/k/a DJ Pauly D.  (But he prefers to go by Paul Won.)  I told him when we started working out together about this surgery, and that I wanted to be as healthy as possible before I went into it.  He helped me achieve this and so much more.  I lost the last nagging 20+ lbs of my pregnancy weight.  I can finally do pull-ups.  I can jump atop plyo boxes without killing or severely injuring myself.  Today I broad jumped 7 feet for the first time ever in my life.  I achieved all of these things with his help.  And after my surgeries, I’ll pretty much be back at square one.

So, I left my appointments at the UW more than a little disappointed and very sad.

I love taking care of our family.  I get an all time high hugging our daughters, squeezing them, even carrying them around and wrangling their octopi limbs down during a temper tantrum.  Every single one of my days revolves around them and I absolutely love that about my life.  I love feeling and being physically strong and independent.  Hearing, yet again, that I need to plan on not being able to do these things and feel very differently for a couple of months is upsetting, to say the least.  So while I’m saying goodbye to my “natural breasts” and to my very high risk of cancer, I’m also saying goodbye to these parts of my everyday that I love so much.  Ergo, the sadness, the disappointment, the fear, the bummers.

I have a case of the bummers.