It's all OK

Writing about cancer is hard. Lots of people get it and write about it and live through it, so it’s not like I have anything of value to add to the conversation.

But then, that has never stopped me from contributing to the conversation in the past, so I will try to explain what it’s like when your body turns against you in the prime of your life.

You just stop

When your cells go rogue, you change courses really fast. Your mind shuts everything else out so that the only thing there is cancer. Suddenly that coworker who you hated and was sucking all the emotional energy out of you means absolutely nothing. That newsletter you were editing is also meaningless.

Everything around you slowly, gradually grinds to a halt.

You stop the process of signing your daughter up for ballet with her friends because you have no idea if you will be tied up with chemotherapy or surgery or what. You waffle back and forth between sending out the custom-made monster-themed invitations to your son’s first birthday party or just saving them all in his baby book unaddressed and unmailed.

You call your babysitter and ask her if she can keep your kids a little later because you and your husband received some life-changing news, and you thank her profusely when she says “of course” with no questions asked and even says her own family’s home-cooked dinner is almost ready and your kids can eat with them.

You freak out but try really hard not to

You sit on the couch with your husband and two Bud Lights and think through the most likely case, even though you have no basis for knowing what your case will be.

You know you have invasive ductal carcinoma. You tell your husband that the most likely thing that will happen is that you’ll be inconvenienced at some point in the next few months with a lumpectomy. A not-too-terrible surgery. And surely you won’t need radiation or chemotherapy. There’s just no way this has spread or will be all that bad.

But what if it is? Pathology reports are hard to read. What you don’t understand, you Google. And when Google tells you that on a scale of one to three, with three being the worst, yours is a three, your heart starts to beat a little faster.  And you start to breathe a little more rapidly.

You wonder if you’re going to die, and you think, no way. I’m not going to die. I’m not even sick. It was just a lump, for God’s sake.

You Google and change lanes

The pathology report says the cells were dividing at a fast pace and there were quite a few dead cells in your two tumors. Which is not really a good thing. Cancer cells live much longer than normal cells, so the fact that they’ve been in your body long enough to have died is not a good sign.

You and your husband keep Googling and Googling until you can get in to see the breast surgeon, and you do this without talking to anyone else because you don’t want to freak anyone out.

At some point in the purgatory between the indecipherable pathology report and the visit with the breast surgeon, you drive alone in your Jeep, and if you’re lucky, you get the sense that I got at this point.

If I die, it will be OK. My children have the most loving, engaged father imaginable. They have aunts and uncles and friends and neighbors who adore them and will make sure that they are raised in a loving environment to grow up and become happy, well-adjusted people (as well-adjusted as can be expected from the Medina/Trice/Allison/Talkington gene pools).

And they would be OK. I would watch from Heaven as they play soccer and learn the piano and have their first crush.

Who says this? What mother in her right mind says it’s OK if she dies before her kids are old enough to start school? I don’t.

I didn’t conjure up this sense of peace on my own. It was God given. Because no reasonable, rational person says they’re ready to die when they’re 33.

But this peace was real and it was pervasive.

I still cried when I leaned over Miles’ crib and swept his messy hair from his face. I cried when I thought about not being there with Allie when it was time to buy school supplies for the first time.

But I knew that God loved us and would take care of us.

And after that realization, I wasn’t scared. I had switched tracks into my alternate reality.  I was in it, and all I wanted was to find out what I needed to do next.

You bask in God's grace

Thankfully, the breast surgeon, Alison Laidley, put everything into perspective for us. She showed us my mammogram films and explained what was concerning about them. She told us why I wasn’t a candidate for the lumpectomy + radiation protocol, and why I’d need a mastectomy of, at the least, my right breast, and likely both breasts. And why she thought that, even though my tumors were classified as grade three, the cancer was likely only stage two.

She freed up my mind so that, even though I never mailed out invitations to Miles’ first birthday or signed up Allie for dance classes, our family was in a good place to celebrate the birthdays of these two little ones.

The invitation that was never mailed (or rotated properly before posting, because Mario took Photoshop off my Mac and made me use a stupid open source program called Gimp, which doesn't work. Go figure.)

Aunt Chrissy came in all the way from Louisiana for Miles' birthday and for moral support for my mastectomy, which took place the day after the birthday party. And that's Aunt Judy in the background, who was diagnosed with stage IIIB lung cancer right around the time I was diagnosed. Mama Toni (my mom) spent 2011 taking care of both of us. And we are both cancer free today.

I never mailed his birthday invitations, but I did make him a cake from scratch! It was horrible -- in taste and appearance.

It was nice being able to focus on Miles' birthday instead of the surgery. That's G-ma sitting on the right-hand side of the picture. (Pretty sure that's her. It looks like her wedding band.) She and my sister Nicole spent the night after Miles' birthday so that Mario and I could leave for the hospital first thing the next morning.

One of my favorite pictures of all time. My son sleeping on my dad. Life does not get any better than this. On the left is Allie sitting on Aunt Nicole's lap (I have good hand recognition. But poor framing skills.)

Allie's birthday, which falls a month after Miles', was also a lot of fun. She got the Barbie Fairy that she wanted. This was the first birthday party that included friends, not just family.

I'm pretty sure I used Evite for Allie's birthday party, and I didn't make her cake from scratch. But Mama Toni bought her the best cake in the world (from Whole Foods), and I made the cream cheese frosting from scratch for her cupcakes!

Saving Skin

Did anyone watch that miniseries on HBO called “John Adams”? There was an episode where his daughter, “Nabby,” had a mastectomy. This was back in the early 1800s. Here’s what a historian James S. Olson wrote about it. Skip down to the paragraph that starts with “The day before surgery…”

http://www.shsu.edu/~pin_www/T@S/2002/NabbyAdamsEssay.html

Yeah, so my mastectomy was nothing like that. I had what they call a skin-sparing double mastectomy. I’m not showing you my boobs, but if you click on the previous link, you'll see some good examples.

Here’s roughly how a skin-sparing mastectomy works.

Your breast surgeon and plastic surgeon, who are in the OR together, figure out exactly where to make a nice, neat little incision. Mine happen to be going diagonally down from my armpits through the center of my nipple. The scars from the incision are roughly four to five inches long. My incisions cut through at about the 10 o’clock angle. I think the doctors choose the incision site based on where the tumor is in the breast. My main tumor (I had two) was at about 10 o’clock.

This was in my right breast.

Even though I didn’t have any cancer in the left side, I opted to have it removed anyway. Because I’m relatively young, the chances of the cancer recurring on the left side were pretty high. So, "cut it off," I said. 

I would have made this decision regardless of what my BRCA gene analysis said, but once I got those results back, it just gave me more reason to have the left breast removed. The test showed that I have a mutation on the BRCA 2 gene, which gives me a higher chance of the cancer recurring than if I didn't have the mutation (it also puts me at a higher risk of getting ovarian cancer, but that's for another post).

I already knew breast cancer ran in my family. My maternal grandmother (a.k.a. Granny, or Betty Trice) had breast cancer twice. She had a mastectomy on one side, went through chemo, and then 10 years later the cancer came back on the other side.

At any rate, you get the idea of why I went ahead and decided to have my left breast removed, even though it didn’t do anything wrong. Which brings me back to my scars. Since they made the incision at 10 o’clock on the right side, they made it nice and symmetrical on the left side.

And here’s where the “skin-sparing” thing comes in to play.  

1.     After she makes the incision, the breast surgeon scoops out all the breast tissue. I imagine this is like scooping out all the seeds and slush from a cantaloupe, only it doesn’t smell as sweet, and the surgeon probably doesn’t throw it down the Disposall.

2.     She scoops as close to the skin (cantaloupe rind) as possible, keeping as much of the breast skin in tact as possible. I’m pretty sure with a radical mastectomy, like Nabby’s, the doctors just lop off the entire boob and keep just enough skin to sew you back up, so you have, basically, your pectoralis major muscle covered with skin.

Thank goodness they have options for reconstruction nowadays. Women who aren’t interested in breast reconstruction can still have a radical mastectomy today. I guess it’s like Nabby’s, only with health insurance, a sterile environment and the anesthesia. Women who don't want reconstructive surgery may go buy a bra with pockets for foam breast forms. Or they may go around flat-chested.

Again, thank goodness for reconstruction. Here’s what that looks like in a nutshell.

3.     In the OR, the breast surgeon gets out of the way and lets the plastic surgeon do his work. Plastic surgeon puts tissue expanders in where my breast tissue used to be. Basically, my skin was like an envelope, and he just slipped empty tissue expanders in there over my pectoralis major muscles. (Technically, the top part of the tissue expander is under my pec muscles. But who cares?)

4.     The tissue expanders are empty silicone bags. They have a port or something on them, about the size of a quarter, which you can easily feel if you rub your hand over it (but please don't, or I will kill you). During my surgery, my plastic surgeon filled up the bags with a little bit of saline, just so I’d wake up and have a little bit of boobage going on. I can’t imagine what a shock it would have been to wake up and have been totally flat.

5.     Over three or four weeks, I healed from the surgery. But I still go back in to the plastic surgeon every few weeks so he can inject more saline into the tissue expanders. He injects a needle connected to a giant syringe filled with saline into the port of the tissue expander. (Super fun photo of this below.)

6.     He’s filling up the expanders so that my breast skin stretches out a little. Yes, the surgeons spared as much skin as possible, but I still don’t have as much skin as I did before the surgery. So he’s stretching the breast skin little by little. He puts about 60 ccs of saline into each tissue expander every time I go in.

7.     Yes, my boobs get bigger and bigger after every injection, which is awesome if you're me or if your name is Mario Medina.

8.     In order to eventually end up with natural-looking boobs, the plastic surgeon will fill the expanders 30% larger than the size that I'd eventually like to be. This is so there’s room for a little “hang.” Not like post-two-kids hang, but maybe like a 16-year-old's boobs hang.

Check out the wallpaper at my plastic surgeon’s office. This is the wallpaper of a gynecologist’s office, not a plastic surgeon's. Someone should tell him.

But tissue expanders suck. Here’s why:

They feel like rocks under my skin. I can feel the rippling of the bag. They make my boobs look like they’re right under my chin. They’re not meant to be permanent.

So, in a few months, I will have another surgery to have the tissue expanders removed and silicone implants implanted.The same type of silicone breast implants that you'd get if you were going in for an augmentation surgery.

Hopefully that helps explain my comments on Facebook/Twitter… especially the one that said, “At roughly $1/syringe, it costs about the same amount to fill my boobs with saline as it does to fill my Jeep with gas #breastcancer.” 

Fun Mastectomy 2011 Photos!

I thought I'd end that title with an exclamation point to give it that "Spring Break 2011" photos feel. You will see some boobage in this set of photos (well, really close to boobage), but it ain't the kind from the beach, I can assure you. These are gross. But, again, I'm posting this for the next 33-year-old who's diagnosed with breast cancer. Just so she knows what drain bags look like, you know?

I'll start with something cute. This one's from Allie. She's really into drawing smilie faces these days. She draws Mommy Smilie Faces and Daddy Smilie Faces. Her drawing sessions go something like this:

Allie: Mommy, woo sit down heow (here).
Me: OK, Allie.
Allie: Woo want me to dwaw a pitcha for woo, Mommy?
Me: Yes please, Allie.
Allie: Woo have a big head, Mommy. Now I dwaw woo eyes and woo mouf.

It used to end around there. But the other day, she went a little further.

Allie: Heow's (here's) woo boo-boo, Mommy!

She had drawn a circle roughly where one of my drainage grenades would be. She then drew three more. She knows exactly how many boo-boos I have. Here's the resulting picture.

Allie's Picasso-esque vision of Mommy with her boo-boos.

So, now for something a little more realistic. Here's a photo of the nurse holding one of the drains that she had just removed from me. I had four of these suckers. Two on each side.

One of my drains. Which look remarkably like grenades, don't you think?

I've never been so happy in my life as I was when that final drain was removed. My sister-in-law, Chris, was with me during this appointment, which ended at about 11:20 a.m. We immediately went across the street to Mattito's so I could have a late-morning celebratory margarita.

OK, so the next photo is pretty gross. You can see a lot of bruising from my mastectomy. This is actually much better than it was a few days ago. You can also see the two holes from where the drains were. Thanks, Chris, for taking these nasty pictures.

Chupacabra holes.

Okie doke. That's enough nudie photos of me. I'll wrap this post up with a sweet video that Sabra, the children's governess, shot just before I came home from the hospital. Love how Miles whacks his sister in the head at the beginning.

Take care, Everyone. As always, thank you for your prayers.