Pre-Op Checklist and a Physician Mandated Trip to Nordstrom

pre op tubesThis week I needed to head back to the hospital for another round of pre-op questions and tests.  I decided to combine the stop at the pharmacy (to drop off the heavy antibiotics and narcotics scripts for post-surgery) and the trip to the hospital with my morning run.  The whole trip would only be 3-4 miles, but I failed to realize that the first mile and a half was almost completely uphill.  I think I’ve been spending too much time on the nice flat parts of the trail– I’ve forgotten what a workout those hills can be!

Between the hills and the fact that it is June, I was pretty sweaty by the time I got to the hospital.  Everyone kept offering the empty chair next to them, but I was too sweaty to sit in a chair! So I hung out with my Spotify tunes and water bottle on the floor. The woman who pre-registered me for surgery has pre-registered me at least once or twice before. It’s always a little strange when someone at such a huge place recognizes me. And the woman doing the blood draw was also a familiar face.  Next time (though let’s hope there’s not a next time!) I’m going to have to remember to ask her not to use the tape that they put on after the blood draw, a band aid would be fine.  It left a much bigger mark than the needle!

I also had the requisite 30 minute nurse phone interview where I had to recount my entire medical history. I can’t imagine what that phone call must be like for someone who’s older and has lots of meds and decades of surgeries to recall.  Mostly, after I went through my surgeries list, I just said “no” a lot. I’m apparently as healthy as a horse. Except for that pesky cancer.

So surgery’s coming up next week.  I’m hopeful for an easy recovery.  I’m not supposed to run for six weeks, but I did get my surgeon to concede that I could ride a bike, so I’ll have to do that.  I don’t have to wear a compression bra, but I wasn’t in love with the compression gear he suggested if he does lipo on my tummy. This would be a good time to point out that it never hurts to ask if you have a question. While the high waist girdle with suspenders (so wretched for July!) was the best option from the company whose brochures they have in the office, a quick chat with Cami let me know that a pair of high waisted spanx from Nordstrom would provide just as much compression without the waistband issue that they’d had with the non-suspsender girdle.  And since the Spanx don’t have zippers down the side, they can go in my regular Spanx rotation. Win-win.  One more trip to Nordstrom, a few last runs, and I’ll be ready to head back to the familiar confines of outpatient surgery.

What to Wear to the Plastic Surgeon | Fat Grafting and Liposuction Edition

wntw plastic surg

Today as I was getting ready to head to the plastic surgeon’s office for my pre-op appointment, I went, yet again, through the long process of deciding what to wear.  It was hot, a perfect day to wear a dress.  Only, once you have breast cancer, every doctor wants you to undress from the waist up before you don a paper gown.  So no dress or you end up wearing nothing under that lovely paper gown.  So jeans maybe.  Only, no jeans that are too low rise, remember you’re sitting on a table sans shirt, and well, you know.   Also no jeans that are too tight at the waist. Nobody wants to show off a muffin top. But after choosing just the right jeans/short/skirt, you’re not done. If it’s a visit involving liposuction (which mine was– for the fat grafting) you need to wear the good panties.  You’ll have to be able to drop trou to show off your “donor sites.” Which means you get to show off the parts of your body that you think are the fattest. Awesome. Tummy as a donor site means just unzipping, but if you’re considering the flank (yep, that made me feel a bit like livestock) you have to shimmy down those shorts all the way to show off your outer thighs.  Which is a good time to point out that you should consider doing all your <ahem> grooming before this appointment.   Not only is this important for the part in the office with the surgeon, but also the part later where pictures are taken.  No paper gown, pants around your ankles, and someone takes pictures of you in your panties (I told you to wear the good ones!), zooming in on your breasts and your fat parts. I mean, donor sites.  So when I said you need to be comfortable with your plastic surgeon and the staff, I really wasn’t kidding.

The good news from my appointment today is that my surgeon said that I don’t have to wear the compression bra after the surgery. That’s huge.  His real concern is that donor site, which, let’s face it, could use some compressing anyway.  So I’ll have four to six weeks in that compression gear. The not so good news– while he said that there is “ample volume” (thanks) to use the flank as a donor site, the fat might not be quality fat.  Apparently, all fat is not created equal, and since he already did liposuction in that area, it might have compromised the quality of the fat for future use. So we chose my abdomen as a back up donor site. I’m not thrilled with that prospect because it means wearing the high waist girdle, which will be pretty hot in the summer months.  You know you’ve reached some sort of low when you’re hoping to just wear the low waist girdle for six weeks.  So fingers crossed that my flank has some good, quality fat. At least I only have to wait a couple more weeks until I know whether my fat is quality fat.  And until I can begin the countdown to the “this is really the last time I wear compression gear” day.

Prescription: District Taco | PTSD and Cancer

 

logo_home-4f80f071f7676deaac829abe23bec48fSlowly but surely, I’m finding friends, groups, communities where women feel free to share their experiences with breast cancer. While every single woman is different, it’s remarkable how we are all united by our experiences. And while I know we all hate that someone else feels the same way we do, it’s so comforting to not be the only one feeling that way. It is so reassuring to realize that what you’re feeling is normal.

Last week, I took part in a discussion* on twitter about PTSD and cancer. Yes, that’s post traumatic stress disorder, but in survivors of cancer instead of war or natural disaster. I read up on PTSD before the discussion, and found that it is characterized by an extreme reaction to a trigger that reminds the patient of the trauma. I hadn’t ever thought about PTSD in terms of cancer. Apparently, many people will avoid driving the same route they had to go to chemo. PTSD interferes with some peoples’ ability to go to check ups with their oncologists because of the extreme reaction just to walking into the office.  Even a simple sound or smell can trigger extreme anxiety. While I certainly have more anxiety about little aches and pains than I did pre-cancer, I quickly realized that I am fortunate that I do not have full-on panic attacks as I drive past Virginia Hospital Center.  For those suffering from true PTSD in relation to their breast cancer diagnosis and treatment, the doctor moderating the discussion suggested the women slowly ease themselves back into the situation that causes their anxiety.  I guess forcing new experiences on top of the old trauma will eventually help neutralize the strong anxiety.

As I was listening to the discussion, they mentioned that many patients experience this avoidance without such an extreme reaction.  And then it hit me.  Maybe this is the reason I tend to avoid District Taco. When Sally and I discovered it, just after the taco truck became a full-fledged restaurant, I would find any excuse to eat there.  Since it’s close to me and not Sally, she and I would eat there almost any time she was in the neighborhood. Which included after many of my chemo and doctor appointments.  By the time I finished chemo, I really wasn’t all that interested in eating there anymore.  I know all about food aversions associated with being sick, but since chemo never made me sick, I figured that had nothing to do with it.  I’ve been back and didn’t have a panic attack, the food was as yummy as ever, but my enthusiasm is clearly dampened. But as it turns out, it’s apparently pretty normal that my brain shies away from things that remind it of chemo. And to retrain my brain, a real, bona fide doctor said that I need to eat more District Taco. (Kind of, but I’m going to run with it.) That’s a prescription that’s easy to take.

*The #bcsm chat occurs every Monday night at 9pm on twitter.

Missing Cancer | Doctor Appointments

The view from the exam table at my plastic surgeon's office
The very familiar view from the exam table at my plastic surgeon’s office

I was talking with a few women last week, all of us had been through breast cancer treatment or were in the midst of it.  We talked about lots of things, but eventually got to talking about our doctor appointments. During treatment, I might have one week with no appointments, but the next week, there was at least one appointment and one trip to chemo. Even after chemo was over, I had countless pre-surgical and post-surgical appointments.  I sat in this exam room once every week or two for months going through the expansion process that led up to my final reconstructive surgery.  Even after that final surgery, there are still lots of follow ups.

After spending so much time with kind, compassionate doctors, it’s like leaving friends behind once you’re released to visit only once every six months. Every woman who had finished her treatment could remember the strange feeling of saying goodbye to a favorite doctor and the staff. Being free of all those appointments and interventions should be cause for celebration! But as much as we all loved seeing the familiar faces, there is a reassurance when you see a doctor every week or two.  Even if they’re not doing any scans, even if you are seeing a surgeon who is primarily concerned with aesthetics.  There is reassurance to knowing that you are in the presence of a trained physician, surely if he says you’re ok, then you’re ok.  Even if it’s just a chat, surely the oncologist can see if there is a problem, right?

I truly enjoy chatting with my physicians, we usually talk far more about non-medical things. I feel certain that, had I met them under other circumstances, we would have been friends. But there is the subconscious, the unverbalized reason that it’s hard to wait six months before heading back to put on that awful “open in the front” paper gown. There something so reassuring about hearing a professional tell you everything is ok.  So now I’m hoping that it’s reassuring enough to last for six months, until my next appointment.  I definitely didn’t recognize it at the time, but I really do miss all those appointments.

This post is part of a series of what I’ll miss from my time as a cancer patient.  I know cancer is a serious thing, not everyone tolerates treatment well, and not everyone recovers.  I don’t mean to offend by making light of a serious subject.  These posts are just a glimpse of my efforts to make the best of my situation—to find the silver linings wherever I can.

Triumph of Ambivalence | My Arlington Magazine Feature

photo 2I love having a local magazine– one that features the best shops, restaurants, and stories about neighbors. It’s not uncommon for me to see a familiar face in the pages of Arlington Magazine. What is uncommon? To see my own face on those pages. And yet, there it is, complete with my name at the byline and Sally’s with her first in-print photo credit. Subscribers already have their copies, and Autumn assures me that covet and other local shops will have copies on the newsstands sometime this week.

Regular blog readers will recognize parts of this essay, where I was privileged to share a little about my journey through breast cancer and why I’m uncomfortable with the term survivor. The editor suggested the title: “Triumph of Ambivalence,” and I have to admit that I did a little googling before I agreed. But simply defined, ambivalence refers to mixed feelings– having both positive and negative feelings about something at the same time. And yes, I suppose that describes how I feel about being called a survivor.

Emma Clare looked at it and read the deck (look- I even learned some technical publishing talk!) and asked why the term “survivor” just didn’t feel right. I explained to her that I didn’t survive breast cancer because I’m better, stronger, or more godly. I wouldn’t people to think that. “Well, you’re not.”

But she quickly recovered. “You’re more of a domestic goddess.” Guess I’ll take that.

Domestic goddess, signing out.

Dance if You Want To

I’m betting lots of you have seen the video of the woman dancing in the operating room before her mastectomy. In fact, a few of you have sent it to me! Strangely, I didn’t think much about it, except that I’ve never had a surgery where I was awake in the OR.  They’ve always given me some nice meds in the IV so that I don’t last much longer than the time it takes to get out the door of the pre-op room.  Why was she still awake, I wondered?  And weren’t they worried about the sterility of the environment?  Of course, she is an OB at that hospital, so I imagine she might have been given a little leeway to do what she wanted.

I hadn’t thought anymore of it until I ran across this article last week.  “You don’t have to dance at your mastectomy,” the author wrote. And so I started thinking.  Everyone deals with things differently.  Deborah wanted to dance, it was her way of showing her friends, her family, herself, that cancer wouldn’t beat her.  And that’s ok. But the author of this article cautioned that it’s ok if you don’t want to dance, too. It’s ok if you want to be scared or sad or angry.

It almost made me feel a little guilty.  No, I didn’t have a flash mob in the OR when I had a mastectomy.  But I do try to keep a positive attitude, and make light of the whole cancer thing whenever I can.  I don’t put a lot of sad or angry on this blog, though honestly, that’s because I don’t have a lot of sad or angry to share.  But just because I’m not sad or angry doesn’t mean that I’m better than someone who is. It doesn’t make me stronger or braver.  It just makes me me.  So you be you, and dance if you want to.

On Choosing a Plastic Surgeon

Those first two weeks after I was diagnosed with breast cancer, I went to a flurry of appointments.  There were quite a few diagnostic and follow up procedures, in addition to appointments with my surgeon, my new oncologist, and two different plastic surgeons.  At the time, I’m sure I would have downplayed the importance of choosing a plastic surgeon.  Perhaps my surgeon knew that, and that’s why she insisted that I meet with at least two before I settled on one.

I am certain that I made the right decision when I chose my surgeon.  I imagine if you’re searching out a plastic surgeon for botox or a tummy tuck, you’re either prepared to feel a little vain, or it’s just not something that you even worry about. But if you’re like most breast cancer patients, it can be a little awkward to go into a doctor’s office asking lots of questions about how great you’ll look after he does his job.  I mean, you just want to survive the cancer, right? It shouldn’t matter if you come out on the other side with a great rack.

This is just one place I think my surgeon was great.  He made it very clear from the beginning that he does lots reconstructive surgeries (a must!) and wanted to be sure that I thought I looked good, period, not just good enough  for having had breast cancer.  He showed me pictures of women who had made all different choices– you might be surprised all the choices someone in this position actually has.  Bilateral mastectomy, or single with a lift on the healthy side to maintain symmetry?  Nipple sparing, nipple reconstruction, 3d tattoo? Stay the same size or go bigger?  He was at the same time realistic and optimistic about my outcome.  Not only did he want me to be happy with how I looked, but he wanted to be sure that  he  was happy– that I looked natural and not like some over-done Hollywood B-lister.  Since there is no fat or breast tissue left after a mastectomy, implants alone can end up looking pretty fake, so he uses fat grafting to fill in around the implant.  This means that during the surgery I had liposuction (not enough to really make a difference, though, don’t get excited) and he injected that fat around the implant, giving a much more natural look. He was also very thoughtful about the incisions, making sure that my scars won’t be visible should I wear even a pretty skimpy bikini top.

Being able to talk easily and honestly is so important, this is a doctor who I saw several times a month.  He not only made sure that he answered my questions, but always remembered the name of my husband or what ever friend came along with me, and called them by name when asking if they had any questions. We talked about lots, and as we neared the end of my expansion, I remember him asking if I’d tried on some of my dresses to see if I liked the way they looked, or if we needed to expand a little more.  He managed to find a way to let me tell him what I wanted without forcing me to outright ask for bigger boobs.  And after the final surgery, he honestly wanted to know what I thought, to be sure I happy with the size and symmetry.

Sure, these aren’t the life and death decisions that the oncologist makes.  But when you’re considering a doctor with whom you have to be painfully honest in some painfully vulnerable situations, and who is in control of how you feel about yourself every time you look into the mirror, it’s worth taking the time to make a good decision.