What's in a Name?

The other day, I told my friend that I was going to see Dr. M at ABC Cancer Center, and she replied by frowning, and saying, 'I don't like that name.' Assuming she meant Dr. M's name, I inquired, 'Huh?' It's true - Dr. M does have one of those names where either name could be the first OR last name, so it's slightly confusing the first time - and especially when your husband is the one who makes the appointment, and then can't remember the name of the doctor, and you are madly trying to Google him to look up his credentials. LOL. However, then my friend replied, 'ABC Cancer Center sounds way too cheerful. Cancer centers should not sound that cheerful.'

I had never really thought of it that way. ABC Cancer Center never struck me as overly cheerful; in fact, it seems pretty standard for where we live. Like... if we lived in a state with beaches, it would be something like 'Beach View Cancer Center.' Which, I guess if you think about it, is sort of overly cheerful. I can just see it: Relax to the sounds of the ocean during chemo infusion. Ahhhh, that makes everything okay. At the same time, it's not as bad as something like 'ABC Yacht and Cancer Club' or 'ABC Cancer Center and Mortuary.' Haha. It got me to thinking... I know there is a lot of thought that goes into naming any business, but I bet naming cancer centers is pretty tricky. You don't want to sound overly cheerful or overly morose or overly spiritual or overly pagan or overly anything. Ever since our conversation, my mind has been going non-stop trying to think of what /I/ would name a cancer center if I, like, won the lottery and could start a cancer center. (As my dad explained to me when I was a kid, there are basically two ways you can get something named after you: either you die an early and tragic death, or you donate an assload of money. The latter seems much more appealing.) But even the Waning Moon Cancer Center has a somewhat morbid sound to it. 

At any rate, I am going to see Dr. M at the ABC Cancer Center tomorrow. (Maybe he can do something about this god damn cough, which I swear is a greater life threat to me than cancer at this point.) I mentioned that Dr. L had suggested waiting until I had my oncotype results to start seeing oncologists; however, Dr. M is going on vacation the week after next, and surgery #2 is scheduled for the week after that. According to my secretary ( = my husband, in case you are new here), he called Dr. L to ask her what to do, and she said to go ahead with the appointment tomorrow, and if we were happy with Dr. M, we could likely communicate by phone with him before surgery #2. All we really need to know from the oncologist prior to the surgery is chemo port or no chemo port, and since I'm reeaaaaally praying to all the powers that be that I do not need chemo, I'm not that worried about it. But then again, I'm not that worried about it in the same way that I was not that worried about my mammogram a little over a month ago, and look how that turned out. 

Reality Check Cancer Center. Maybe that's a good name. Leave your dreams and your future plans at the door. You can pick them up on the way out, if you make it. 

Post-Op Appointment

I had my post-op appointment with Dr. L today, and she was amazing, which allayed my fears that she was going to turn into my orthopedist (i.e., super nice but not so super competent). I had a list of questions that I've been jotting down over the last 10 days, but fortunately the regular course of the conversation answered all of them for me, without me having to pull out my notebook and go through the items point-by-point (though I did check at the end, just to make sure). It was a very useful and information-packed 30 minutes, so without further ado, here are the highlights:

• The pain and numbness I'm still having is normal, and should resolve within a few weeks. I've heard that one before, lol, but I am encouraged by the fact that it has gotten significantly better within the past few days. Dr. L said there is no excessive swelling, and that I need to stretch my arm ( = lifting it above my head). This will actually help the pain. I haven't been doing this because it hurts to do it, but apparently this is one of those suck up the pain to make it get better type of deals.
• She also listened to my lungs for me, because I was coughing so much, haha. Apparently they are fine, and this horrid cough is just the usual crud that causes horrid coughs. 
• She went over the pathology report with us. As it turns out, the pathologist went back and re-did a few slides after the initial report, and one of the margins is actually positive for ductal carcinoma in situ. This isn't good, but it's also not a catastrophe since it is 'just' DCIS ( = not invasive... yet), and she had already told me that she wanted to go back in anyway. It just worries me a little that the DCIS is so extensive, and that it really didn't show up on the mammogram, which in my paranoid mind has me thinking it could be all over the place. 
• I asked how she was going to know how much tissue to take out the second time around. She said it was a good question, and admitted that you can't really know for sure. Most people want to err on the side of too much vs. too little, but there is also a certain point at which you might as well just have a mastectomy. So... 
• She was very reassuring that there is a very good prognosis for lumpectomy + radiation, just as good as for a mastectomy. 
• Then we had an interesting conversation about radiation. I've never really understood, on a molecular level, how cancer can be caused and treated by the same thing; how one can receive radiation to kill cancerous cells without causing cancer in healthy cells. And I still don't really understand. Dr. L did say that previous radiation treatments ultimately ended up causing cancer in many patients 10-20 years later, The worst thing is 'a little' radiation, but that 'therapeutic doses' of radiation that are now given are very effective. 
• As far as the timing for surgery #2 goes, she said she would prefer to wait not only for the results of the oncotype, but also until we had met with and decided on an oncologist, and had decided on a definitive plan of action with an oncologist's input. 
• My husband actually arranged three appointments with oncologists next week: one on Monday, one on Tuesday, and one on Wednesday. The one on Monday is with a different oncologist in town, Dr. M. (Unfortunately, there are only two cancer centers in town, so he is sort of the end of the line for in-town providers.) The one on Tuesday is with Dr. U, and I had tentatively planned to cancel that one if I liked Dr. M better than Dr. U. The one on Wednesday is up at University Hospital. 
• However, Dr. L suggested waiting until the results of the oncotype were in because the oncologist would want them before making a definitive recommendation. So, those appointments will need to be rescheduled. Thank goodness I have a personal secretary (i.e., my husband) and I have the summer off, more or less.
• Although all signs point to NOT having to do chemo, it's not a done deal. She said the results of the oncotype change the suggested treatment 50% of the time  - though usually for the better. She said there are some types of cancer for which chemo will actually do absolutely nothing as far as recurrence, and there are some types of cancer for which chemo will reduce the risk of recurrence significantly. The tricky part is the middle ground, and weighing the hellishness of chemo versus the potential benefits in these 'intermediate' cases is when you need a really good oncologist.
• She said there was another test, MammaPrint, that also assesses the risk of recurrence, and some oncologists prefer to use it over the oncotype dx, because it comes back as either yes (do chemo) or no (don't do chemo), and some oncologists are uncomfortable with ambiguity. However, I'm more uncomfortable with an oncologist who is uncomfortable with ambiguity than I am with ambiguity myself. I understand statistics, and the fact that most things aren't black and white. 
• As if she read my mind, Dr. L said she was sure I'd be fine in understanding the numbers, because 'You are smart, and understand numbers' (LOL, I'm not sure how she came to that conclusion after one meeting; hopefully it's not just because I am Asian), but that you had to be careful in interpreting/understanding the results of the oncotype. For example, the results of the oncotype might suggest that chemotherapy will reduce the risk of recurrence by 20%. That sounds significant, but if the risk of recurrence is only 10% to begin with, that only takes you from 10% to 8%. Of course, a reduction in risk is a reduction in risk, but there are side effects to chemo, and if the risk of recurrence is small to begin with, you should consider that. 
• Because I'm a science nerd, and Dr. L thinks I am Smart, haha, I asked her what exactly the oncotype was testing - receptors, mutations, or... ? She said the oncotype dx analyzed 21 different genes with various roles in cancer, and was actually based on a really neat prospective/retrospective study - one in which old tumors were analyzed after the fact. And because they were analyzed 10-20 years later, the researchers knew the outcome of the people from whom the tumors were removed, and could therefore make very powerful correlations between the tumor characteristics and the outcome. So basically it is the best tool we have nowadays. 
• It was really cool to be able to have a 'high level' conversation like this with a doctor. I understand that medicine is part art and part science, the same way that teaching science is part art and part science (and, at my level, more art than science). However, I believe that cancer is a malady that will be cured by biochemistry and molecular biology, more than art, and by doctors who understand science. The most important thing to me in a provider for cancer is that they can talk science, and statistics, with me. 
• As we have been shopping around for oncologists, I decided that I would ask Dr. L for her personal recommendation for an oncologist. I know this gets into sticky territory, as some doctors won't give definitive recommendations, especially for doctors outside of their own practice. But you figure it's worth asking, right? My PCP told me that if it were his wife with breast cancer, he would make sure she saw Dr. L, and since his recommendation turned out to be fabulous, I decided I wanted Dr. L's recommendation.
• Fortunately, at some point, our conversation had a very neat segue into If it were you, who would you choose as your oncologist? territory. Dr. L was actually very open about who she would choose, and highly recommended Dr. M, which made me feel very good. I had been a little concerned because the other doctor who came highly recommended (in the same practice as Dr. M) was booked through June, so I sort of had this feeling that Dr. M was second best. Or third best, or fourth best... (The problem with awesome doctors is that they are usually booked, so you have to wonder about one with open availability.) However, Dr. L said Dr. M was very compassionate, smart, and science and statistics-oriented, and felt he would be a really good fit for us. She actually semi recommended him over Dr. Who Is Booked Through June, which was sort of a relief. (She didn't exactly say this, but she implied it.) She said Dr. Who Is Booked Through June was more on the aggressive side than Dr. M. I mean, aggressive is okay, but aggressive without evidence that aggressive is helpful is another thing, and Dr. L seemed to understand that while I definitely want to be aggressive, I don't want to be aggressive just for the sake of being aggressive (i.e., I'm not one of the Give me chemo no matter what type of people, and probably not even Give me chemo if it reduces my chance of recurrence from 10% to 8% type of people). So hopefully he is just less popular because he is a man who deals with breast cancer, which is sort of like a male OB/GYN. 
• However, Dr. L also said no matter what, it was a good idea to go to University Hospital for a consultation, and was happy we had set that appointment up. At one point, she said she was glad that we seemed to have the 'med onc' part of this under control. 
• On a side note, I stalked Dr. M on Internet and he is an MD/PhD, with degrees from an Ivy League school, which as an academic immediately made me feel good. Nonetheless, it makes me feel much better that he has an endorsement from the medical community as well as obviously being 'smart.' 
• Interestingly, as we talked a bit more, I asked Dr. L what chemotherapy might involve - i.e., what drugs - just so I can Google them and prepare myself, ya know? She said chemo was usually pretty standard and there were basically three different drugs, though given my case, Dr. M might opt out of the one with the most horrid side effects. I'm not sure what the 'horrid' side effects are, but I decided that was a conversation I should have with the oncologist vs. Dr. L. 
• Call me vain, but I really don't want to lose my hair. To me, that's the most horrid side effect of chemo, even more than constant nausea - throwing up, diarrhea, whatever. I feel like I can deal with the other side effects, but I really don't want my hair to fall out. There, I said it. 
• Even though Dr. L (UNFORTUNATELY) won't be in charge of my long-term care, she did discuss options with me, including tamoxifen and shut-down of my ovaries - whether it be chemical vs. surgical. 
• She said that she felt most oncologists would be okay with me taking tamoxifen if I also stayed on blood thinners, given that a side effect of tamixofen is increased risk for blood clots.
• But, that might be 5-10 years, which is a long. freaking. time.
• I mentioned that I was fairly certain I didn't have a clotting disorder, and asked if it would be possible for me to have my blood clot re-evaluated. She said that unfortunately, regardless of prior history, the single best predictor for blood clot formation, was a previous blood clot. So basically I'll be high risk for blood clot formation for the. rest. of. my. freaking. life. (Have I cursed my orthopedist recently?) 
• Aside from tamoxifen, the other options for hormonal treatment (e.g., aromatase inhibtors) are for post-menopausal women. Apparently some women can't tolerate these, so Dr. L suggested that if I went that route, it would be better to test the medications before doing something permanent, like having my ovaries surgically removed. She also said that the ovaries can be shut down medically through a shot, which basically makes you go through menopause in, like, a few days, which is Not Fun. So basically being on tamoxifen and Xarelto for 10 years is pretty much the most appealing option at this point, which is pretty freaking depressing, though not a shock. I feel like I sort of already knew this, though it was different hearing it from Dr. L than from Dr. Gloom and Doom (Dr. U). 
• IF I do chemo, the order of events is surgery, chemo, then radiation. Radiation is a given. Pretty much. I mean, obviously no one can MAKE me do it, but basically I won't find a board certified doctor who will tell me it's not a good idea. 

The GOOD NEWS is: 

• Going on vacation is absolutely doable, according to Dr. L. I realize that vacation is small in the you are going to live vs. you are going to die scheme of things. However, I'm also a numbers person. If starting treatment at end of June/beginning of July vs. middle of July/end of July means a 0.001% or 0.01% or even 0.1% or 1% reduction in the chance of recurrence of my cancer, I'm all for the vacation. 
• However, Dr. L actually said that she didn't think there was much, if any, significance in when I started Part 2 of my treatment, as long as it was within three months post surgery #2. 
• I figured a person who deals with cancer patients might not have a lot of patience for patients (haha) who were trying to plan their life around vacations; however, she understood. My life has already been turned upside down, or at least sideways. Vacation is important. Maybe now more than ever. 
• She was willing to work with us as far as us still being able to take our vacation. Furthermore, she was willing to work with us as far as her own vacation plans went. 
• She said that she was going on vacation June 19th-30th, and given that we were hoping to leave June 27th, it was possible to aim for surgery #2 before she left. She was a little uncomfortable waiting until after we got back, theoretically on July 11th, and therefore agreed to 'make time' on June 17th for the 're-excision.' So June 17th it is. This should give us time to get the oncotype results and consult with an oncologist, and also give me enough recovery time to be able to travel on June 27th, even with a chemo port. 
• She said surgery #2 should not be nearly as bad as the first one, given that the lymph node biopsy is the worst part, and she won't do that the second time around. 

Overall, it was an action-packed appointment, with a lot of information. Most of it was not new, but somehow it was still a lot to take in. When I first got into the room, the MA had me change into a robe (I love that they have real, cloth robes that they heat up for you - none of the ridiculous, scratchy, paper robes!); however, I never actually sat up on the examining table, just because I didn't feel like it. And Dr. L never asked me to sit up on the table, she just sat down across from me and even did her physical exam while I was sitting there in the regular old chair. At one point during our conversation, she actually moved next to me and put her arm around me, though in retrospect I feel sort of bad because I'm pretty sure I just sat there like a stone statue, which is nothing personal, just my normal reaction to people touching me. LOL. However, before she left, I did thank her profusely for calling me on Friday night, so hopefully she knows I don't hate her for having to be the bearer of bad news. 

For the Love of God...

I was up all night coughing, and therefore woke up in a ridiculously bad mood, even for me. I woke up in a coughing fit seven times between when I turned the lights out (11 PM) and when I had to get out of bed to go the bathroom (3 AM) due to the huge mug of herbal tea with honey I drank right before I went to bed. Along with my bouts of waking, I was also having some sort of angst-filled dream, which I don't really remember, and wouldn't recount here even if I did, because IMO there is nothing more boring than listening to people blab on about their dreams. But the relevance of the angst-filled dream is that every time I woke up, in that delirious half-dreaming, half-awake state of not really knowing what is real and what isn't, I was certain I was having a pulmonary embolism, and was ready to call 911, until I finally woke up enough to realize that I was only dying in my dream. Oddly enough, I went through this same thing all seven times that I woke up. How does that saying go? Fool me one, shame on you. Fool me twice, shame on me. Fool me seven times, shame on me, shame on me, shame on me, shame on me, shame on me, shame on me, shame on me.

Anyway, I finally caught some sleep between 3 AM and 7 AM; I think waking up enough to go to the bathroom let me shed the I am dying dream, and I moved onto one of my dreams where I actually tried to kill someone. (True story, but I promised not to bore you with my dreams, so I won't say who it was.) Needless to say, I was pretty unhappy and tired when I woke up at 7 AM. My husband told me to try to get some rest - to call my parents to help with the kids and to send them out to his mom's once she woke up. (His mom lives in a cottage in our back yard.) 

Now, here's the thing. Neither my parents nor my husband's mom are super helpful as far as watching the kids goes. My parents are pretty good about watching the kids if I'm in a bind, or if I plan it way ahead of time, but my mom usually makes it way more complicated than it needs to be, to the extent that sometimes it's just easier to not ask. And my parents would never be like, 'I bet you need some rest, let us come get the kids and take them to the park!'

My husband's mom is a different story. She is in her 80s, and has severe arthritis, and can't get around very well. I am fine leaving my nine-year-old with her for a few hours at a time, but my three-year-old is a different story. I'll leave him with her for, like, 20 minutes if I have to run to the grocery store or the pharmacy or something that I can do very quickly without a three-year-old in tow, but otherwise he doesn't spend a lot of time with her.

However, due to the events of the past month, my son has been spending a lot more time with my mother-in-law than usual. This has been a good thing, for the most part, because it has allowed me to grab cat naps here and there, get grading done, get stuff done. Don't get me wrong - I am grateful. Unfortunately, my MIL and I don't see eye-to-eye on a lot of things. I could make a long list of Things That Are Annoying About My MIL (can't we all?), but most of them are pretty benign. For example, my kids watch a lot of videos when they are out at her house, which they rarely get to do, because we aren't big TV-watchers. I've accepted it, and they have an arsenal of videos to choose from at her house. 

Probably the biggest source of tension, and one that has become magnified within the past month, is that neither my husband nor I are religious, whereas my MIL is. It's somewhat of a conflict for us, because neither of us were raised devoid of religion, so it's not necessarily that we want our children to be reared in a bastion of Atheism. But... we aren't church-goers, and I honestly don't see that changing. My MIL has always used her time with my daughter to push her right-wing agenda and introduce her to God and the Bible. (I drew the line at Fox News, LOL. The rule is that they can watch videos, but no TV at her house.) It's mildly annoying, but... like I said, it's not as if I'm opposed to my kids knowing Bible stories or even believing in God. I mean, heck, I grew up going to Sunday School, and I didn't end up marrying a man with six wives at the age of 16 and popping out 12 kids. So... whatever. 

Unfortunately, it has become painfully obvious to me over the past few weeks that my kids have been spending way too much time with my MIL. My daughter keeps going on about the Bible says this and the Bible says that and my son carries around flagstone 'tablets' and a staff and talks to bushes. Yesterday, we were in the car taking my daughter's friend home from a play date (which, by the way, is the first time I have driven since surgery - YAY!), and my son was holding his 'tablets' and his staff, and my daughter was listing the Ten Commandments. My daughter's friend is not religious, so she was just sitting there while my kids carried on like they were part of the Duggar family. 

'No other God,' my daughter declared. Then added, 'No false idols.'

'Set the people free!' my son bellowed out in his deepest, most Godlike, talking bush voice.

'Don't take the Lord's name in vain,' my daughter continued.

'You mean like this?' I said, 'Jesus freaking Christ!'

'How dare you!' she gasped, genuinely shocked.

'No killing,' I reminded her. 'Or stealing,' just to at least make sure she remembered the two I actually don't have a real problem with. Then: 'No TV!' I added, just for kicks.

'That's not one of them, Mom,' she said matter-of-factly. 

'But it's one of mine, and you have to honor me,' I said back, matter-of-factly. 'Honor thy mother and father.'

(Oooooh, this is getting fun!)

Clearly, this presented a conflict. So then she said, 'In one of the stories in the Bible...' 

I cut her off. 'I am SICK of hearing about the Bible! No more Bible for the rest of the trip.' Then, for emphasis, I added, 'For the love of FREAKING GOD, let's talk about something else!' 

I keep asking myself what I did to deserve this, besides get cancer and pawn my kids off on my MIL for a few hours a day, for a few weeks! It is almost like God is punishing me for not believing in Him. LOL. I've said before that I'm not a great mom. I never have been, so I can't blame it on the cancer. I don't purposely try to be a bad mom, but I'm a lazy enough mom that if I have the chance for my kids to spend time away from me, I jump on it. I've always rationalized this by telling myself that my kids are better off spending their time with someone who is warmer and cheerier and more loving than I am, and who actually enjoys playing Go Fish. 

But now it is abundantly clear to me: it's time for me to start working on Mom skills again. Because Jesus H. Christ, enough is enough.

Finally, Some Sun

After about two weeks of cold and rain and hail and lightning and all sorts of gloom and doom weather, the sun is finally out today. Just in the nick of time. We aren't used to this type of weather here; even normal people were getting ready to kill themselves. Yes, people here are wimpy about gray, rainy days. And really hot days. And humidity. And bugs. And snow. LOL.

So I am at the one-week mark, and it still really hurts to move my arm. I am wondering if I should be worried. I hope Dr. L doesn't turn into my orthopedist. I seriously think that's my greatest fear. What if she is not as awesome as I think she is?

Aside from the not being to move my arm thing, I am doing well, at least as far as post-surgery recovery. My GI distress is FINALLY gone, and my appetite is back. In case you don't know me, the not eating thing was actually sort of alarming, because I am most definitely not a person who has trouble eating. Like, ever. Unless I am extremely sick or extremely, EXTREMELY stressed out, I am always up for food - anything from gourmet to the most unnatural and disgusting of things that you can't even really call 'food' (e.g., Cheetos). We ordered Vietnamese food last night, and I couldn't wait for lunch today to eat the leftovers. That hasn't happened in a long time.

Also, I know I'm feeling better because my hip has started hurting again. LOL. Awesome! In reality, I don't think it ever actually stopped hurting, it's just that I wasn't paying attention to it. The fact that I'm noticing it again at least indicates that other parts of me (both physical and emotional) are hurting less. Last night as I lay in bed, I realized that both my right hip and ankle were throbbing (though my left hip feels pretty good, so that is a plus). My ankle started hurting about a month ago, and I am certain it is related to the fact that I seem to have developed a permanent limp.

It's sort of a pathetic predicament I'm in. I'm obviously not in a position to do anything major about any orthopedic conditions at the moment, and quite frankly, after all the injections I've been through, I can't imagine going in voluntarily for even a cortisone injection. At the same time, I bemoan the fact that it took me so long to find the lump in my breast due to my preoccupation with my hips, and now I do not want to let the rest of my body go to hell just because I have cancer. I need to figure out a way to at least manage my hip, and now ankle, pain through all of this. I did this last night by taking a hydrocodone, but hopefully there's a better long-term solution.

I don't mean this lightly; I am working on an actual real plan for this, and am contemplating trying to squeeze in a visit to my new orthopedist. Or PCP. Or something. In the meantime, I am going to try to get back to doing my self-prescribed physical therapy regimen, which involves stretching, light exercise, and ice. I need to stay in/get in shape and take care of my whole body. This is war, after all.

Post Lumpectomy: Day 6

It is cold and rainy outside, which is ridiculous for where I live at this time of the year. I feel cold and rainy inside, too, which is pretty normal for me. LOL. I am not a cheery person. I am, however, powered by sunshine and nice weather; it combats the stormy, gloomy person within. Needless to say, 10 days of rain and no sun and too much thinking about cancer have not done good things for me mentally.  

My family is still off camping, so I'm enjoying another day of doing nothing. Highlights of the day thus far include: deciding that this blog needs a face lift (ongoing project), and receiving a phone call from a friend, during which I discovered that my cold has taken away my voice. I croaked my way through a brief conversation until I just couldn't talk anymore. 

Otherwise, I am feeling pretty good after two back-to-back nights of eight hours of sleep. (Thank you, Ambien.) With the exception of my arm, I feel like I'm pretty much 'over' the effects of surgery. I can move my arm a little better, though it is still ridiculously painful considering all I had done was have 7 little itty bitty lymph nodes removed. (Well, that, and a 4.5 cm ball of tissue scooped out, but supposedly it's the lymph nodes that hurt the most, which at least makes me hopeful that surgery #2 won't be as bad.)

I spent most of the morning playing on my computer, trying to get motivated to do some actual work stuff, but not succeeding. As I perused the news, I was sad to see that John Nash had been killed in a car accident. At the same time - and forgive me, this is going to sound super insensitive - it's not the saddest story out there. I've always been the type of person to contemplate death a lot. (See paragraph #1: I am cold and rainy.) My reflections on death have led me to probably the same conclusions anyone who thinks about death a lot would come to: there's not really a great way to go. Call me cynical, but even the super religious people who claim they can't wait to meet their Maker don't have me convinced that they are truly excited about dying. I do think that some diseases are so horrible and take so much of you, including every last drop of dignity, and cause you so much pain, that you reach a point where you give up and stop fighting. The anticipation of A Better Place must be comforting in those final days or months or even years. Which brings me back to my original point: dying in a car crash at the age of 86 isn't the worst way to go, in my opinion. The most upsetting thing about car crashes, and other accidents, is that they are unexpected. No one anticipates dying in a car crash. (Planes are different story; take it from someone who is terrified of flying.) When your husband tells you he is taking the kids camping for the weekend, you fully expect them to return, without getting into a fatal car accident on the way home. The surprise element of someone dying unexpectedly, and often prematurely, is the horrifying part, not usually the death itself. 

Don't get me wrong, I'm not saying I want to die in a car accident. But, I don't want to die of cancer, either. Or Alzheimer's. Or a stroke. Or be shot to death. Or drown. Definitely not ALS. There isn't really any way I can think of that I want to die, but... we all have to, eventually, and some of us sooner than others. And no matter what, it is probably going to suck. If it is an unexpected death, you likely won't have gotten very far through your bucket list, and the shock will be hard for loved ones to absorb and accept. If it is expected, that means it will likely be preceded by a long and unpleasant struggle. Which one is worse? I don't know. And really, there is no point in contemplating it, because very few of us will actually choose how we die. 

How is that for a rainy day thought? God I need some sun. 

Post Lumpectomy: Day 5

Over the past 24 hours, I've developed a mildly annoying cough, and I'm really glad I've had so many scans so I can feel fairly confident that it's just a cold and not, you know, metastasis. That, and I have a sore throat, too. Throat cancer? Unlikely. LOL. Occam's razor, baby.

Unfortunately, I realized today that this entire ordeal is not going to be good for my hypochondria, because for the rest of my life I will be convinced that I have cancer and that it is killing me. (And hopefully this won't actually be the case.) And the sort of weird thing about my particular type of hypochondria is that it is not true hypochondria, because usually when I am convinced there is something wrong with me, there actually is. I only joke that I'm a hypochondriac because I spend so much time worrying that I think there is something wrong with me, when there really isn't, that I actually don't go to see a doctor very often, because I figure that I'm just being a hypochondriac (when in reality, I'm not).* In a way it is like reverse hypochondria, sort of like the reverse placebo effect, which is my made up term for describing the fact that whenever I finally make a doctor's appointment, I start to feel better. 

Kudos to you if you followed that.

* As evidence of this, I present to you: cancer! After discovering the lump and consulting with Dr. Google, I did not feel good about the prognosis, even though everyone convinced me that I am way too young and way too Asian to have breast cancer. Fortunately, I decided to see the doctor, just to ease my hypochondriac feelings. 

Anyway, today was an utterly useless day. My family is still off camping, and I pretty much feel like crap - more because of my cold than surgery, I think. Fortunately, I was able to lie around and do nothing all day, and I didn't even feel that bad about it, because I sort of feel like I deserve a day of lying around and doing nothing. Aside from my arm, I feel pretty normal. But I've sort of stopped caring about the pain from surgery going away, knowing that it just going to be back when I have my second surgery in, like, a week. So whatever. I am such a ball of joy today, aren't I? I know I am getting back to normal because I am a) SUPER CRANKY and b) able to drink alcoholic beverages again. 

My appetite is also slowly returning, so hopefully by tomorrow I can cross anorexia off my list of potential ailments, haha. But the stress of the past few weeks combined with the GI distress from the past week did at least allow me to finally drop the five pounds I can usually only lose if I stop drinking (which my friends and family agree is no fun). Silver linings, silver linings. But speaking of weight, here is an absurd but true story. I had to get weighed before surgery, which seems fairly important, right? So they don't put you under with a dose of medication meant for a 300-pound person? And I can understand why they don't just take your word for how much you weigh, because everyone lies about that, and it's probably hard to judge a person's weight when she is wearing a surgical gown that is meant for, well, a 300-pound person. Anyway, I stepped on the scale, and because hospitals are finally trying to join the rest of the world and use the metric system, the weight is in kilograms. The nurse immediately chimed in to let me know, 'That's kilograms, not pounds.' LOL! Yes, yes, I am aware that I have lost some weight in the past few weeks, but HELLO! I also realize that I do not weigh 60 pounds!! Okay, so maybe that was one of those 'had to be there' things.

Finally, I got a really sweet delivery of four bottles of wine today, from my BFF from college, with a note that said: If I lived closer, I'd bring over my favorite wine every time you needed a little cheering up. Since I can't be there in person I'm sending this so you can know my thoughts and love are with you all the time. Thank you so much RAJ! XOXO! And I will 'see' you all tomorrow.

Pathology Report

My husband took the kids to a music festival, where they will camp out for the weekend. I don't camp even when I'm not recovering from surgery, but it was nice to have a legitimate excuse not to go. Somehow the I don't camp and you can't make me excuse seems to wear off after a while.

Anyway, I was settling into a quiet evening of alone-ness, trying to figure out what type of food I could possibly keep down, when my cell phone rang. I didn't recognize the number, but I answered it, and it was Dr. L. calling me with the pathology report. At 6:30 PM on a Friday evening. (Did I mention that I love this woman?)

As soon as I realized it was her, my heart started pounding and I immediately started trying to read her voice for any signs of good news/bad news. I couldn't get a good read, though, either because she is a seasoned pro, or because she was delivering a mix of good news and bad news. Fortunately, she delivered the bad news first, which is the way I like it. 

The bad news is that the pathology report shows that were extensive regions of ductal carcinoma in situ (DCIS), more than expected. (I'm not even sure any DCIS was expected.) DCIS is sort of a weird beast; it's not invasive, but it can become invasive, and it is a definite risk factor for the development of invasive tumors in the future. And since I HAVE an invasive tumor, we know I am prone to developing invasive tumors, so basically DCIS is not something to fuck around with. 

Dr. L explained that the tumor of invasive ductal carcinoma was 1.3 cm in diameter, which is almost exactly as expected, based on the many measurements I had done through many different scanning processes. However, the area including DCIS was 4.5 cm. And while she did think that she got all of it out, the margins were not what she would want - only 0.5 mm. Apparently that's a small margin. She explained that any margin was technically a 'clean' margin, but... she would feel more comfortable if we got a little more. Which means she wants to go back in and do another surgery and take more tissue out. UGH!! She said that if I were 60, she would be perfectly okay with a 0.5 mm margin, but since I'm only 40 and obviously 'high risk' due to the fact that I HAVE an invasive carcinoma, she thought it would be safer to go back in and take a little more out. Did I already say UGH?! On a side note, it's hard for me to believe that she took out over 4.5 cm of tissue and my breast hasn't, like, collapsed in on itself or something. (For the record - in case you are wondering, lol - I don't have particularly large breasts.)

But, that is the bad news, and in the large scheme of bad news, it isn't too bad. Honestly, I think I'm dreading the f-ing shots in the stomach more than the surgery itself. Have I cursed my orthopedist recently?

The GOOD NEWS - and I know you've been dying to hear this :) - is that she took out seven lymph nodes, and they were all free of cancer. (!!!) This, more than anything, is what I was hoping for. This means it is unlikely that I will have to do chemotherapy, which is... awesome. That's the thing I want the most - not to have to do chemo. I will need to do radiation therapy, and that's not a walk in the park, either, but I really, really don't want to have to do chemo.

I'm not completely off the hook yet, though. Dr. L thought that we should send the tumor off to get an oncotype, which basically predicts the probability of a tumor coming back, as well as how likely I am to respond to radiation and/or chemotherapy. She said this would give us more information as far as treatment goes, then added jokingly 'unless you just really want to do chemo.' HA HA! I assured her I did not, to which she replied, 'Yeah, I didn't think so!' 

I asked her what the timeline was for the second surgery and she didn't really give a definitive answer. It's sort of STAT and sort of not. She said it would be helpful to have the results of the oncotype at the time of surgery, because if chemo were recommended, she would insert a port during the surgery. (Ugh, I do NOT want to think about this!) In the end, we decided to discuss everything in more depth at my post-surgery appointment on May 28th. 

Overall, it is not the absolute best news, but it is very good news, probably as good as it gets these days. Because the cancer has not spread to any lymph nodes, at least that we can tell, it is considered Stage IA, which is the best thing you can have with an invasive cancer. The tumor grade, which is different from the stage, and essentially determines how aggressive the cancer is, is a G2, on a scale of 4. This is a slight downgrade from the original biopsy that stated the tumor was 'well differentiated' (which would be G1), but the good news is that hopefully it doesn't matter, because it is OUT OF ME. As far as I'm concerned, it can keep on growing in the jar if it wants to. LOL. 

On a final note - I was going to write about this in my last entry, but then Dr. L called - I/we (we being my husband and I) decided to shop around for medical oncologists. My parents kept the kids the Saturday before my surgery so my husband and I could have a nice dinner together. It's amazing what type of conversation can occur in the absence of children. Ha. We both agreed that we weren't crazy about Dr. U, and even though we have no idea what an oncologist 'should' be like, we felt like something was missing. I hope Dr. L hasn't spoiled us to a point where no doctor will ever meet our standards now, but we figure we have to try. This is life or death, after all. And that's worth a shopping trip, in my opinion.

Post Lumpectomy: Day 4

And so we wait.

And wait.

And wait.

My PCP told me this would be the worst part, and it turns out it's a true story. You know you have cancer, you just don't know if it's okay to be bemoaning the fact that it is going to ruin your summer or if that is the least of your worries. Should you get busy doing all those DIY home improvement projects you had planned or should you be redoing your will and putting together an advance directive?

Around 11:00 today, I got impatient and sent an e-mail to my doctor via the patient portal, just making sure she hadn't gotten any test results yet. She didn't reply right away, so I thought, great, she must not be working today. It is going to kill me to wait and wait and wait even more over the weekend, but it would kill me even more to think I am waiting while the test results are sitting in her office while she is out golfing. However, around 3:00, she replied:

I am so sorry it's taking so long. I think one of the pathologists is on vacation? I have gotten very few results back from this week, but they are starting to trickle in. I'll keep checking and call as soon as I get them.
Jane Kay Listens

Argh! Pathologists should not be allowed to take vacations!

In other news, I am feeling pretty good today. My arm feels better, and I'm able to move it around without excruciating pain. I still cannot really eat, though. Nothing at all seems appealing to me, and after last night's episode, I'm sort of afraid to try. I'm starting to think it is unrelated to the surgery, and it's just stress. Or, because severe hip pain, DVT, and cancer aren't enough, I also need to become anorexic. LOL.

Other news:

• I got brave and started reading breast cancer blogs. I don't know if this is a good thing or not, because a lot of them do not have happy endings. And let me tell you, an unhappy ending in a cancer blog is a lot worse than an unhappy ending in a hip blog. Nevertheless, I have gotten hooked on this blog: http://www.butdoctorihatepink.com/. The woman who writes it is Stage IV, which is incurable and terminal, which is a bit much for me to think about right now. But she writes with such hilarity, it immediately sucked me in. Also, I Googled 'blogs about breast cancer' and, from the list, chose hers because of the title. I, too, HATE PINK. I mean, pink as a color is, eh, whatever. But I hate pink ribbons, I hate seeing girlfriend-beating NFL players wear pink, and I even hate watching breast cancer survivors wearing pink and running a few miles to 'raise awareness.' (WTF does that even mean?) I hated all of these things even before I had cancer, and I hate them even more now. I will never ever wear a pink ribbon and will never see how donning pink and walking any distance will help any cause. (I also think the ice bucket challenge was the stupidest thing ever.) God that sounds bitter. LOL. But I am a scientist, not a marketer.

• I debated whether or not to share my news on Facebook, and in the end I decided to. Facebook is weird, and I don't post a ton there, but at the same time, most of my Facebook friends are actually people who are important to me. And it looks as if cancer is becoming a big enough part of my life that it would be hard to never ever mention it in a status update. So yesterday morning, I threw together this update: 

I know a lot of people find it hard to decide what sort of information to put on Facebook, but I've gone through my friends list and done some 'grooming' so that my future updates, for those of you who read them, aren't cryptic and WTF?-ish. In the past month, I have wrapped up a semester with the usual work stress, completed a semester-long, time-intensive, EMT course, and been diagnosed with breast cancer. In the past three weeks, I've had about a kazillion appointments, have been scanned in just about every possible way (X-ray, ultrasound, CT scan, MRI, and PET scan), been injected with a lot of mean and nasty stuff (iodine, radioactive glucose, gadolinium, Lovenox...), and had a lot of stuff, some of it mean and nasty, taken out of me (blood, tissue samples, tumors...). I had surgery on Monday and am starting to shop around for a medical oncologist before definitively deciding on the plan for Part 2 of this. If you are one of the people who already knew this, I want to say thank you for all of your support - from bringing me and my family food, to making sure A isn't stranded after school, to covering my classes and even 8:00 finals for me while I went to hard-to-get appointments, to posting ridiculous things on my wall to make me laugh, to supporting me while I cried my way through every single EMT practical last Saturday. I hope to be able to use FB to keep people in the loop without becoming one of 'those' people who shares way TMI. Don't worry - I won't be posting any breast selfies. :)

• I was actually pretty amazed and touched by the outpouring of love I got in response. It was very unexpected, and helped buoy my mood. I figured it would be one of those things a few people would 'like' and a few people would respond to by telling me that they would pray for me. LOL. However, I actually got a lot of really meaningful and supportive replies, which made me glad I had gone ahead and shared. I am not a very open person, except in writing; in fact, I think that is why I have to write. Otherwise I'd probably burst. Sharing things with others is a big step for me, and I'm glad I didn't end up regretting it. 

I started writing this about three hours ago, and while I was writing it... my doctor called. I will write about it in a different post.

Drumroll, please.

Post Lumpectomy: Day 3

They say no news is good news, but in my case, I really think no news is just... no news.

And for once, I have complete confidence that my doctor actually will call me as soon as she has news, so no news actually is... no news. With that said, there is not a lot to report on the cancer front.

However, I am happy to say that I felt soooo much better today. I still feel very tired, and it still hurts like a mother fucker if I move my arm around a lot, but basically I feel like someone who just, like, broke their arm. Or something. (I've never actually broken my arm, so I have no idea what I'm talking about.)

Anyway. Some random, but related, thoughts: 

• I mentioned to a friend the other day that one of the issues with this whole ordeal is that I can't sleep. I've always had trouble sleeping, but this just makes it worse. Ever since I started having severe hip pain over a year ago, it has been hard for me to sleep on my right side, and now I can't sleep on my left side ( = bad boob side). Plus, the stress and yadayadayada. She came over to bring me a full body pillow, the type you use when you're pregnant, which actually helped a lot. 
• I belong to a book club, and way back when, before cancer was even on my radar, I volunteered to host the May book club at my house. My book club friends know about my ordeal, and have been super awesome about it, and I ended up having the book club at my house tonight, despite everything. And it was actually really good, because I needed a distraction, and... because, despite everything, I really want things to be normal. Like... yeah, this cancer shit has thrown an unexpected curve ball into everything, but I really don't want all my conversations with my friends from here on out to be about cancer, cancer, cancer... I want to talk about other stuff, too - the things we've always talked about.
• Hosting the book club wasn't a huge ordeal, because one of my friends came over early to help me clean, then another came over, and the three of us made Chinese dumplings together. And afterward, friends cleared off the table and did the dishes, and it was really pretty relaxing overall.
• The only unfortunate thing is that I haven't eaten solid food in a while; I'm not sure if it's post-surgical stress or stress in general, but I haven't eaten normally in at least a couple weeks, and I have not really eaten solid food until today. Tonight, I ate and drank normally (including a few glasses of wine), and geez did I pay for it. After everyone left, I didn't feel great, but thought, eh, whatever. I started to do a little cleaning in kitchen, but soon found myself throwing up violently. WTF? I haven't even started chemo, but it's like my body is preparing itself for chemo with premature gastrointestinal distress. All I can say is if I don't at least lose some freaking weight after all this, I'm gonna be pissed.

But the good news is that aside from the whole throwing up thing and a lot of fatigue, I felt pretty normal today. The friend who helped me clean before book club also brought me a sling that her husband got when he broke his elbow, and that has since been used by both her kids for broken arms. Being able to rest my arm helped a lot. I'm hopeful that by tomorrow I'll feel even more normal - at least like I did after the biopsy, which was like I'd been punched in the ribs, but otherwise okay. And, of course, I'm still hoping for news tomorrow - one way or the other. Today, I was still feeling enough after effects from surgery that I wasn't really ready for any news; I really just wanted to worry about healing. But tomorrow, I think I'll be feeling normal enough that I'll be feeling like bring it on. One way or another, just bring it on. 

Post Lumpectomy: Day 2

I am feeling a lot better today, as if a fog has lifted. I took my last pain pill around 4:00 yesterday. I was tempted to take another one last night, but instead opted for half of an Ambien. It was a good decision. The pain when I move my arm is still pretty intense, but I fashioned my old graduation hood into a sling to give my arm a rest, and Dr. L assured me via e-mail that the pain is normal. As long as there is not excessive swelling, it's okay. (Should I trust her?)

So I'm just sort of sitting around today, in that anxious state of feeling much better, but not good enough to really do anything, and therefore not really wanting to look good enough that it appears like I should be doing something other than sitting around. I did, however, take a shower today (hurray - it has been 48 hours!), put on semi-real clothes, and manage to put my contacts in (which wasn't easy). This afternoon I will be accompanying my husband and kids to gymnastics lessons. My husband will be driving, but has a teleconference that starts in the middle of their lessons, so I will go along to help herd cats once they get out of their lessons and he is on his teleconference trying to hide the fact that he is at gymnastics lessons with his kids. I think I can handle this small task, plus it will be good to get out of the house. Hopefully. Unless my son has one of his Mother Of All Meltdowns, which is a realistic possibility. 

In other news, Dr. L also said via e-mail that she was expecting the pathology report back from my tumor today, and that she would call me as soon as she got it. The good news is that I actually believe her, because she has been very good about calling me STAT with results, and when I sent her an e-mail this morning about my pain and when to expect results, she replied within a few minutes. The bad news is that if she does call me today, it's looking like it is going to be at a bad time (bad = lots of other people around), unless she calls within the next ten minutes. Oh well. It will only be really bad if it's bad news, so I guess I can just hope for good news. 

Imagine that, hoping for good news. 

Post Lumpectomy: Day 1

Needless to say, I'm feeling significantly better than I did yesterday, but I still feel a lot worse than I expected. I know, I know, it has been less than 24 hours, I'm just a very impatient type of person and I have a hard time staying still. I'm still taking hydrocodone regularly, which is making me very sleepy, but it's better than throbbing pain. The worst pain is in my axilla/armpit area, which Dr. L warned me about. She said there are a lot of nerves in that area, and taking out the lymph nodes 'tends to piss the nerves off quite a bit.' She also said it was likely I would have worse bruising and a slightly slower recovery than normal because of the blood thinners, but that 'it's better than a PE' (pulmonary embolism). I'm sort of terrified to move my arm around. I really want to put my contacts in so I can feel human, but I'm not sure if lifting my arm up is a good idea. I just managed to get dressed, and I think that was enough arm movement for an hour.

Anyway.

What a looooong day yesterday was. My parents came over in the morning to get the kids off to school. My husband and I left the house around 7 AM for my 7:30 appointment, mostly because I wanted to leave before my son woke up, because I knew that would make it a lot harder to leave. My 7:30 appointment was with radiology to get an injection to help with the sentinel node biopsy. I got an injection of a radioactive tracer into my boob, right next to my nipple, around 8 AM. That was not fun, but as I told Dr. L later, it wasn't as bad as the Lovenox injections. After the injection, I had to wait around for almost two hours to let the tracer get absorbed. I knew this would be the case, but unfortunately, that waiting was in the waiting room, so I couldn't really take a nap as I had planned. (My husband managed, though.) I tried to read a book, but couldn't really get into it, so instead I spent my time being annoyed by and glaring at the noisy group of people next to me. Haha.

Around 9:30, we went back for the typical pre-op stuff: people confirming my identity and the surgery I was planning on having approximately ten kazillion times, vitals, medical history, etc. Since pretty much everyone I talked to seemed fascinated that I was on a blood thinner, I told the story of my hip surgery and DVT over and over, to the extent that I was sort of worried that people would forget I was in there for breast cancer. But it's true: I know I'm about 30 years younger than the typical person with a history of hip problems and DVT, so that makes the story interesting.

When the anesthesiologist came in to talk to me, he went over his gig in about 30 seconds. (There's not much to say except that he will put you to sleep and keep you asleep.) Then said he had read my chart and wanted to ask me about my hemoglobin E, if I didn't mind. It didn't have anything to do with the surgery, he was just curious. So we then had a 10-minute conversation about hemoglobin E. He was sort of like a kid in a candy store, or like a doctor who had wanted to go into hematology but instead got into an anesthesiology residency, haha.

I openly shared information with people, keeping in mind what my EMT instructor had told us: you will learn the most by talking to other people, and most people will talk to you. People with certain disorders will, for the most part, know more about their disorder than you do, and the parents of kids with certain disorders will very likely know more about their kid's disorder than you do. So you should educate yourself by asking them about it. What better thing did I have to do while sitting around waiting for surgery than to help educate people?

I was surprised they actually took me into the operating room fully conscious, which was kind of creepy. I actually got up and put myself onto the operating table. In the past (not that I have a long surgical history), I've always been knocked out before being in the OR, so I've never actually seen the inside of an OR before. After I positioned myself on the operating table, the anesthesiologist told me he was going to give me something that would knock me out in 10 seconds, and then the nurse stood over me and told me 'We're going to take good care of you' until I fell asleep. It was a nice touch, and I actually remember it.

After I woke up from the surgery, I remember them telling me to open my mouth, and feeling them take the airway adjunct out me. I think I only really remember this because one of the skills in my EMT class is inserting airway adjuncts, and they just seem so weird to me. They are big and bulky, and I just don't see how they help (but obviously they do). They are really easy to insert into dummies, and apparently just as easy to insert into real people. In fact, C, my friend from EMT class, who also works at the surgery center where I had my surgery, told me I would probably have an OPA (oropharyngeal airway) during surgery, and I told her it better be out of me before I woke up. LOL. (The contraindication for an OPA is that the patient is conscious.) Later C told me they had actually used an LMA (laryngeal mask airway), and they have to wait until you wake up to take it out, but you aren't supposed to remember it. Ha!

The next thing I remember is the post-op nurse asking me what my pain level was, and in my grogginess I made something up and told her between 5 and 6. So she gave me some fentanyl (I think?) through my IV. I actually felt okay until I tried to move, and moving my arm caused extreme pain. A few minutes later, she asked me what my pain level was. I said it was about the same, so then she gave me something stronger. (Dilaudid? It started with a d, that's pretty much what I remember.) After that, I felt okay, until I tried to actually move again. Later when she asked me my pain level, I said it was still around 5 or 6, but I didn't have the energy to explain that I actually thought it was better, it's just that it had actually been worse than a 5 or 6 to begin with. So she gave me two hydrocodones, and after that things got pretty fuzzy for a while. LOL.

Eventually I came out of the fuzz, and C came over and we talked about the EMT practical exams and various things, and after about an hour and a half, I was ready to leave. Getting dressed was the biggest challenge, and set off the excruciating pain from moving my arm. In my pre-op phone appointment, the nurse had mentioned that wearing a button-up shirt might be a good idea, but I don't have any comfortable button-up shirts I would want to hang out in all day, or that I would want contaminated by a hospital environment, so I ignored that advice and went with a t-shirt and zip-up sweat shirt. At least I was pretty comfortable for the rest of the day.

I got home and tried to sleep, but I was still spinning from all the pain meds, so it was a weird type of half sleep. Eventually I tried to watch a movie, but I wasn't awake enough to understand what was going on. My mom came over and brought some soup, and I eventually stayed awake long enough to eat some, and it helped a lot, because I hadn't eaten anything in about 20 hours at that point. Then a friend came by with a pizza, which was super nice. (My family enjoyed it while I dozed off.) After the kids were in bed, my husband and I decided to wind down by watching a movie (the same movie I had tried to watch earlier), and it was pretty stupid, so I actually fell asleep for a little bit. I slept on and off throughout the night and woke up around 4:30 with terrible pain. So I took a pain pill and actually did sleep really well after that for a few hours.

I dozed on and off all morning, and in between dozing had some more soup, tried to answer a few work-related e-mails, and write this. Just before lunch, a friend came by with some soft camisoles for me to wear and stool softener. LOL. (She reminded me that stool softener is an important thing that they may or may not tell you about, but after two C-sections and another surgery, she would never forget how necessary it is, haha.) We visited for a while, and now I think I'm ready for another nap. But my pain does feel a lot better, so I think I'm going to try not taking any meds for a while. I'd like to be lucid for at least a little while.

Overall, I'm feeling a lot better than even this morning, and am hopeful I can continue on this recovery trajectory.

Lumpectomy

What a dumb word. I hate it, just like the work bunion. What hideous terms.

Anyway, this will probably be fairly short because the pain from the surgery was really a lot worse than I expected, and I'm on a lot of pain meds. I feel sort of drunk, but at least the room has stopped spinning. When I got home, I was so tired, but I really couldn't sleep deeply because of the spinning. I'm hoping that the crappiness I'm feeling now is due to fatigue, and that a good night's sleep (if I can manage one) will help.

So I survived, obviously. The surgery went well, I think. At least there weren't any unpleasant surprises, and now we're just waiting on the pathology report to determine the future treatment. I'll write a detailed post tomorrow - think of this as a trailer - but I just wanted to let you all know I'm doing well and feeling pretty positive. Thank you so much for your continued thoughts; it means so much to me.

I get by with a little help from my friends...

I'm not sure if this is really stuff I should be posting in a public place, but... here goes. It's the age of People Sharing Too Much Information, right?

I woke up this morning feeling extremely ambivalent, and unsure. Unsure about myself, and about everything. My husband was extremely sweet and got up with me and made me breakfast, then went back to sleep. I knew it was unlikely I would be hungry for lunch, so I really tried to eat breakfast, but I've basically felt sick to my stomach for the past two weeks. I don't feel like eating, and whatever I eat causes extreme GI distress. Enough said. In my stress, I managed to give myself the most painful Lovenox shot so far, and boy do I have the bruise to prove it. Ugh.

Around 7:30, I headed off to try to pass my EMT practicals. The day did not start off well when I promptly failed the first two exams. One of them was CPR with AED (automated external defibrillator), which is absolutely ridiculous, because basic life support for healthcare providers (which is essentially CPR with AED) is actually a prerequisite for the EMT class. Apparently I did my compressions too slowly, which was in direct response to everyone telling me I was going way too fast the last time we practiced. Also, when I did my artificial ventilation exam on Wednesday, I was worried I did the ventilations too fast and thought I might fail because of it. You're supposed to ventilate at a rate of 10-12 ventilations per minute for one minute, and I was at 14 when the proctor told me to stop, but I passed anyway - either because he wasn't counting closely or he actually let me go for more than one minute. Anyway, I realize you do everything faster when you're nervous, and I heard one of the women who came out of the exam right before I went in say that the proctor had told her she had done her compressions too fast, so I was making a conscious effort to not go too fast. I guess I waaaaay overcorrected. But hey, at least I respond well to criticism!

I was super pissed about the other exam I failed, because it was a simple splinting exam, and I did it just as I had practiced it at least 20 times in class, and no one had ever told me it was wrong. I felt better that the other people who got the same splinting scenario as I did also failed, because they also did it the way we had practiced it in class, and no one ever told them it was wrong either. And honestly, I still don't believe it was wrong, but... whatever. Oh the joy of learning something one way, then having to pass an exam with strangers who think it should be done another way.

The proctors don't tell you if you passed or failed; they just send your evaluation sheet off to a 'courier,' who delivers the sheets to your instructor, who then comes and finds you if you failed, and discusses the reason you failed with you. (So you know it's bad if you see him coming toward you.) Sometimes it is totally obvious you failed - like, if a patient dies on you, lol - but I was honestly pretty surprised (VERY UNPLEASANTLY) about both my fails. I found out about the splinting fail first, and was pissed, but still okay. Fortunately I had taken (and passed) another exam before I found out about the CPR/AED fail. I found out about the CPR/AED fail while I was waiting in line for another exam, and the proctor of the exam just happened to walk by and sat down to tell me in person that I had gone too slowly. UUUUGH!! I mean, he was nice about it, and somewhat apologetic, considering he had watched me do it during class several times and told me it was fine. Somehow I managed to hold it together to get through the exam I was waiting for (and ultimately pass it), but when I got out, I was feeling extremely overwhelmed. The remaining exam I had - medical assessment - is my (and everyone else's) nemesis. By the time I had the news of my TWO failed exams, almost half the class had already failed medical assessment, which didn't make me feel very confident. Facing that exam, plus my two failed exams, was waaaaaay too much for me and my ridiculously limited capacity for stress.

The atmosphere in the classroom became unbearable at some point; my head was about to explode listening to people bounce various scenarios off each other and talk about what they had failed and why, so I went to try to find a quiet spot in the hallway to just... chill. Eventually my instructor found me to tell me I had failed the freaking CPR/AED exam, which I already knew, and even though I had been holding it together up until then, I LOST IT, and started crying right in front of him. And that was The Worst Feeling Ever, because even though I have spent a lot of nights crying myself to sleep in the past few weeks, I have not ever cried in class before. Or at work in front of my colleauges. Or even in front of my own freaking family. And once I start crying, I can't stop (which is probably why I'm so good at holding it in - it's all or nothing for me). My instructor was, of course, super awesome, and told me I didn't have to finish today if I couldn't do it, but that if I could do it, 'I'll be sure you pass.' If not, he would be happy to make arrangements for me to do the exams later, when I was feeling better.

But the thing is that later is only going to be worse. There is no 'feeling better' for me in sight. I said I really wanted to do everything today because I felt like it was now or never for me. Then my instructor said, 'You're not getting off that easily. I'm going to be sure you pass eventually.' I looked at him pathetically and didn't say anything. The thing is that I really did want to pass, but I definitely didn't want to pass just because he felt sorry for me, or because he knew that I had no intention of actually being an EMT. Like... I have pride; I wanted to pass legitimately. Then he looked me in the eye and said, 'The reason I'm going to make sure you pass is because of all the people in this class, you're the one I would trust the most to take care of me.' That honestly took me completely off guard, especially after all of my doubts about my abilities to actually DO stuff, versus just read about and understand stuff, and especially after comparing my skills against my much more skilled classmates. I mean, it was a HUGE and overwhelming compliment considering that of all the people in the class, I would not be my own first choice of people I would want to care for me. So I reacted in a completely appropriate way to his compliment <insert sarcasm here> by BURSTING INTO HYSTERICAL TEARS. OMG it was completely mortifying, but at the same time, I was so out of sorts I didn't even realize how completely mortifying it was, sort of like when you are giving birth.

It was honestly one of the most humbling experiences I've had in my lifetime, because I can't think of a time where I've ever cried so hysterically in such a public place before. I know stress during the practical exams is a given, and the exams are actually designed to make you feel that stress, because being an EMT is a stressful job, and they want to be sure you can handle it (hence why I will never be an EMT). At the same time, it was sort of humiliating to think that all of these people were thinking that I was crying hysterically over exam stress. Aside from the woman I had already told about my ordeal, I did end up sharing things with a few other people, but I'm sure the rest of them (including a former student and current student in my department at ABC college) just thought I was hysterical over the exams. But in the end, I just had to stop worrying about what everyone was thinking about me and just try to worry about passing my three freaking exams.

And... I did. I have a strong suspicion that my instructor told the proctors to be nice to me, lol, but... whatever. You still have to complete all the skills on the checklist no matter what, and I know I did that, so I feel good about it. And the funny thing is that after all was said and done, I passed the medical assessment on the first try, whereas over half the class had to do that exam twice, and that was the one that I had never successfully completed in class.

I think the most amazing thing is that after my breakdown, a bunch of my classmates really rallied for me, and were so super kind and supportive that I now feel I need to pay things forward for a hundred years to make up for it (especially considering most of them thought I was just crying over exam stress). One of the guys - to whom I eventually told the whole story - was soooo nice, and hung out with me while I was in a crying fit, and kept asking me if I wanted food or water or anything, and ahhhhhhh. I seriously felt so weird he was being so nice, but eventually he said to me, 'You know, you're the ROCK of this class. You're always in class, and you're one of the reasons I've loved coming to class. So whatever you're going through right now, I want to be the rock for you like you've been for me.' Of course I responded to this by crying hysterically. Awesome. I don't even know this guy's full name, and when I came out of my final exam, he was gone. I hope I can track him down.

When I finally left, with my certificate in hand, my instructor gave me a huge hug, and I started crying all over again, which was super embarrassing, but since almost everyone else was gone at that point, I just let it go. At some point during the hug (and geez, if you know me, you know I'm not a huggy person), one of the women who has helped with the class regularly, came in and told my instructor she would take over for him (hahaha, like relieving someone of CPR). This woman is super scary, and has pretty much never passed me on anything I've ever done, and I figured that based on her compassionate response, she knew what was going on. But it turns out she didn't, so I eventually let her in, and she responded by telling me that she had had cancer, and it pretty much sucked, but she was here, and alive. Then she grabbed me and was like, 'You just have to do whatever you have to do to get it out, and you don't take no for an answer!' and followed this with some huge pep talk. I mean, I realize that it's not always a question of just chasing the cancer out of your body, but to have this woman, so full of piss and vinegar, tell me this, was soooo fitting. Based on my experience with her, I can just imagine her standing around screaming, 'FUCK YOU, CANCER, GET THE FUCKING HELL OUT OF MY BODY!!' It really inspired me to stay positive, and to beat this shit. It's going to suck, but I'm going to do it.

I've done things without friends before, but man, it is so, so, SO much easier with a support network in place. And I thank God for that.

End of the Semester

I wrapped up the semester today - finished grading exams and posted grades for almost 200 students. It wasn't nearly the joyous experience that it normally is, considering summer is looking as if it isn't going to be all that fun. Also, having my EMT practicals looming over me is causing way too much stress, and even though my instructor told me I could do them at another time, I just have to try. The thing is that I know I am going to be upset if I don't pass, while at the same time realizing that it is very realistic that I might not, because my mind is not clear and I have basically not slept or eaten well in, like, three weeks. I really don't want to go into the lumpectomy feeling all super bummed out and woe is me, so I have to manage my expectations and not freak out if I don't pass. I have yet to NOT kill a patient during the practice medical assessments we've done, but supposedly the scenarios they give you during the actual testing are not as complex, and they won't make you chase a disoriented and combative psych patient around for 10 minutes, so we shall see.

Anyway, in other news, I started the Lovenox shots today, and just like pretty much everything about all of this, they really suck. I remember it being really unpleasant when I got the shot in the ER, but I didn't remember it hurting for so long afterward. But maybe my technique is bad, lol. When I picked up the shots from the pharmacy, the woman asked me if I need a pharmacist to show me how to administer them, but somehow the idea of standing in the middle of the pharmacy with my shirt pulled up and my fat rolls hanging out seemed horrifying, so I told her I could figure it out. And really, it's not that hard. You gather up all your stomach fat, stick the needle in, and push down on the plunger. Even though the needle poke doesn't really hurt that much, that's the hardest part for me. I have to lie there and take deep breaths and count to three over and over before I can get myself to stick the needle in. I mean it's one thing to have someone give you a shot, but it's another thing to have to do it to yourself. I really feel for people who have conditions where they have to give themselves shots on a daily basis, although I imagine it gets easier with time. Still... ugh. I thank God for the company that came out with Xarelto!

Hopefully my next update will be a cheery one, and not a hysterical, pathetic one like the last one I wrote after I failed an EMT practical. If not, I apologize in advance. I also want to thank you all for your love and support. I want to reply to all your e-mails, and I will eventually, but I hope you can accept this generic thank you for now.

Meeting with the Medical Oncologist

Today I met with Dr. U, a hematologist/medical oncologist. The meeting was sort of... meh. Dr. U was fine. I didn't LOVE her, but then again, how much can/should you love an oncologist?! LOL. I realized when I was walking up the stairs to the appointment that the building was not a happy place in general. The entire building is a Cancer Center, so you have to figure no one going in or coming out is ecstatic. Dr. U was pretty much all business - definitely no warm fuzzies - but I guess that goes with the territory.

Anyway, the appointment was not super informative, as Dr. U said her recommendation would depend on how the surgery went, as well as the final pathology report from surgery. She said the report usually takes two weeks, but that she wouldn't recommend starting any sort of treatment until at least 2-3 weeks after surgery, and probably more like 4-5, because you need to give your body time to heal. So... she counseled us against taking our family vacation in July, because it's very likely that I'll be starting a treatment right around that time. If it's radiation, that's not something that can be easily done on the road, because it is every day single day, Monday through Friday, for six fucking weeks. If it's chemotherapy, I'll basically feel like crap and won't feel like traveling. So that pretty much sucks. And of course we have paid for everything already. So that sucks even more. Overall, everything pretty much sucks right now. I know, I know, cry me a fucking river, right? Feeling pissy over replacing two weeks on the beach with chemotherapy is such a first world problem.

Then we talked in very general terms about what some of the possibilities are. Basically since I'm opting to not have a mastectomy, some sort of follow-up will be necessary, whether it is radiation or chemo. If the sentinel lymph node biopsy that will be done during surgery comes back negative, meaning the lymph nodes are free of cancer, radiation combined with some sort of hormone therapy will be the likely recommendation. Depressingly enough, this is the best case scenario. If the lymph nodes are cancerous, some sort of chemotherapy will be necessary, and the exact type would depend on the pathology of the tumor.

As far as hormone therapy, Dr. U mentioned that tamoxifen, which is an estrogen blocker, was sort of 'old school' and would not necessarily be her first choice for me, given that I am only 40, and there is significant risk of the cancer coming back in my lifetime. She said for younger women, it's often more effective to just shut down the ovaries altogether, either through drugs or just taking them out. Either way it is basically a forced premature menopause. I'm not sure how I feel about this. It's a lot to digest. I am, however, thankful that I am done having kids, because I can only imagine what this would be like for a woman who still wanted to have children. As if the cancer isn't enough to deal with, having to consider your future fertility adds a whole new dimension of stress. I remember when I was pregnant with my daughter, we lived in a very sketchy place, and most of the other women in my birthing class were, like, half my age. The only other woman who was 'older' and actually had a husband said she had had ovarian cancer. Needless to say, she and her husband were THRILLED to finally be having a baby.

And speaking of taking out parts... Dr. U discussed the results of the PET scan with me and said that the spot on my rib didn't show up on the scan, which is good, although she did mention that sometimes small spots wouldn't show up, even if they are cancerous. (Like I said, there weren't a lot of warm fuzzies going on. LOL.) However, she said my uterus was of concern and that I would need to have a pelvic ultrasound sometime soon. W. T. F. ? She did say that body parts could appear bright for any number of reasons on a PET scan, so it could be nothing, but that we would definitely need to get to the bottom of it. In the end, we agreed that I would see her in three weeks and we would schedule the ultrasound at that point. Because that is JUST what I need right about now, another body part to worry about! OMFG!

The one thing I was really surprised about was the timeline for everything. I guess I was naïve in thinking that I would have most of the treatments done by the end of the summer. But geez, it's not as if I have experience to draw on. Either route will most definitely drag on into the fall, which is a good thing to know now. Dr. U said that although there were fewer side effects from radiation therapy, it was very time-consuming and would probably also make me feel tired. It's not just the fatigue from the radiation itself, but also the fatigue from the amount of time it takes, and the stress from the amount of time it takes. And it goes without saying that chemotherapy would make me feel like ass. (It gives me the heebie jeebies that there is a wig clinic right next to the doctor's office.) She said that teaching through this might be easier than a regular 8-5 job, because at least there's some flexibility, but that I should probably consider trying to get a reduced load or ask for some accommodations or... something. Wait. Haven't we been here before? God the past year has sucked.

After the appointment, I went up to work to pick up the exams from the final my colleague gave for me this morning. We talked for about an hour then I went home, picked up my daughter from school, and then crashed into a deep, deep sleep. Needless to say, I have not been sleeping or eating well. The only good thing about all of this is that I finally lost those five pounds I've been wanting to lose. LOL. What can I say, take the small victories whenever you can.

Get Over It

This post has nothing to do with hips or cancer. I started to write it on my other blog, but I didn't have the energy to make it work there, so I will post my thoughts here. Everything in my life right now is intertwined.

The past few weeks have been a whirlwind and have involved incredible amounts stress while I've gone to tests and appointments after tests and appointments, have tried to wrap up my semester at work, pass my EMT class, and keep my family and social life intact. I do not handle stress well to begin with, and the past few weeks have really been testing my limits.

I mentioned in a previous post that while I was really trying to hold everything together until this Saturday, and really hoping to pass my EMT class, that this is not easy for me. I am a book person, not a hands on person - the type of person most normal people make fun of. I know what a narrowing pulse pressure means and why, but I struggle to take blood pressure accurately, even though this is a really basic skill that most minimum-wage health care workers are expected to have. I can tell you, step-by-step, what you are 'supposed' to do during a medical assessment, but yet I always miss one of the critical steps when I am actually doing the assessment myself.

EMT certification is a different beast than even Highly Technical Skills you encounter in science. Due to my extreme incompetence in hands-on stuff, I've really tried to lay low and not even let it be known that I teach at ABC college. Unfortunately, it somehow came to be known that I teach at ABC college (not sure how), and this just adds more pressure in terms of feeling like I can't fail. I think part of it is the perception that people in academia think they are super awesome, and thus people outside of academia like to show these super awesome people that they aren't as awesome as they think they are. While I've never tried to give the impression that I am super awesome (and ironically, years in academia have proven to me that not only am I not awesome, but I am also actually a Piece Of Shit not even worthy of attending meetings for the Truly Awesome, so basically I have no self-esteem whatsoever), I cannot help but feel the weight of people thinking that I think I am awesome. Yeah, it's complicated. You are awesome if you followed that.

I'd be lying if I said that passing this EMT class didn't mean a lot to me. It does. I have put so much effort into it, and it is so far out of my comfort zone that passing is really a symbolic thing for me. But I also realized tonight, which was our last 'formal' class period, that I'm really going to miss the class. As crazy as it has been trying to work and take this class, it has been a huge part of my life for the past five months.

I mentioned that on Monday, I had told my instructor what was going on, and that he was super awesome about all of it. After taking the written final, I didn't feel awesome, but felt like I had probably gotten at least 75%, which is all you need to pass the 'academic' part of the class. When I came in today, he asked me if I had gotten his text, which I hadn't - probably because due to all of this crap, I ran out of minutes on my cheap, $12/month cell phone plan. He then told me that I had gotten a really high score on the final (95%) and he had texted me right away to let me know because he knew I was stressed about it. (Seriously, that's so nice.) Later in the evening, we had a deeper conversation about... stuff. Perhaps because it was the last class of the semester, he mentioned that he really wanted to sit down and talk about 'classroom management' with me, because he wanted to improve his teaching, and figured I knew a little about teaching. He also asked if I'd be interested in guest lecturing about anatomy and physiology in the future, because it wasn't a strong point of his. I assured him that I'm not an expert on teaching, and really enjoyed the class and learned a lot, and in the process of being a student and instructor at the same time, had gained a lot of insight into my own teaching (which is really true). I said I 'd be happy to come talk about A&P, but that he did fine with it. I mean, yeah, he wasn't the greatest teacher, but the reality is that in emergency medicine, most of what you do comes down to pretty simple things (ABCs - airway, breathing, and circulation), and a thorough knowledge of pathophysiology won't really change how you treat a patient. (You even treat hypo- and hyperglycemia in the same way, the idea being that someone who is hypoglycemic will benefit from the treatment, while someone who is hyperglycemic won't be harmed by it in the pre-hospital setting, so you shouldn't bother trying to figure out the difference between the two.) In fact, a thorough knowledge of pathophysiology will probably just frustrate you, like my current job frustrates me, lol. In the end, my instructor told me it had been really fun to have me in class, which actually meant a lot, because I really tried very hard to just be a 'normal' student and not obnoxious, while at the same time sharing what I did know about certain things. I'm glad he recognized that.

Anyway. Unfortunately, tonight wasn't all happiness. Since we had the written final on Monday and our practicals were supposed to be this Saturday, tonight was supposed to be a practice day for Saturday. However, when we got to class tonight, the instructor said that he had figured out it wasn't possible for all of us to get all of our practicals done between 8 and 5 on Saturday, so we would do three of them tonight. I was completely unprepared for this mentally, but at the same time figured it might not be a bad thing. It would be nice to get a few of them out of the way, and at least the surprise element meant I hadn't had to be stressed about it all day/week. I mean, I wasn't thrilled about it, but you just have to go with it. It is emergency medicine. LOL. You could NEVER get away with something like this at the university, but like I said, this is a different beast.

The good news is that I passed two of the practicals - two that although considered two of the simplest things EMTs do (oxygen administration and ventilation), were really stressful things for me. (Oxygen tanks and I do not get along, to the extent that it is a joke amongst my class.) The bad news is that I really fucked up on of the exams, which was the simplest thing ever (bleeding and shock management), and I failed. It is not a huge thing to fail, and actually plenty of people failed at least one of the stations, but still. I was so pissed off with myself over such a stupid thing that I should have seen coming, that when my instructor came to talk to me about it I almost started crying. He knows what I'm going through and knows I'm on the verge of breakdown and was trying to be super nice about it, but I still almost lost it.

The most ironic thing about this is that in terms of work, I'm at the point in the semester when I'm dealing with students who are begging me for a higher grade, and I'm like, wait, you FAILED two out of the three tests, and you are asking me for a C as opposed to a C-?! You should just be happy that you got a C- considering you got F's on two out of the three exams! And here I am, crying because I let someone bleed a few seconds longer than he should have, when in reality I should be rejoicing over the fact that I managed to administer oxygen to a patient without turning the oxygen tank into a bomb. I should just be happy I managed to pass SOMETHING!

I'm honestly not sure if I was so upset because I was truly upset over the stupid freaking exam (which I will have the opportunity to retake on Saturday), or if it was just all of the emotions of the past few weeks pouring out, along with the unexpected stress of having exams tonight. People tell me that I seem very calm and unemotional about things, but the reality is that could not be farther from the truth. I held it together in the classroom, but immediately started to cry when I left, and have pretty much been crying ever since (and it is almost 2 AM, so clearly I need to go to bed).

I hate crying, but what I hate even more is crying for a reason I don't understand. If I'm crying over the practical, then I'm pissed with myself for letting that get to me, but at the same time, if I'm crying for another reason, that's pretty fucking stupid, too. Whatever it is, I just have to get over it. Because if I am crying now, what lies ahead is going to be really super pathetic. And being really super pathetic, well... makes me want to cry.

PET Scan + Genetic Counseling

Wow, things are moving so quickly, and I am so wrapped up in my minute-by-minute survival, trying to make sure that I'm in the right place at the right time and my husband is in the right place at the right time, that I apparently forgot to share some big details. (I also tend to lose track of what I've shared with whom and who knows what and how.) I alluded to it in my last post, but apparently never actually mentioned that I called first thing on Monday morning to schedule surgery. I now have a lumpectomy scheduled for next Monday, May 18th, and although everything is happening so fast that it is slightly overwhelming, I'm also glad it is happening so fast. As Christine commented in my last post, 'Get that shit OUT!' My sentiments exactly. I think no matter what - i.e., regardless of the results of genetic testing (see details below) - I would proceed with the lumpectomy, even if something more major is in my future. The chances of me having one of the high-risk mutations like BRCA1 or BRCA2 are low, but even if I do, and even if I decided to have a double mastectomy, that's something I would need time to wrap my mind around. In the meantime, I am anxious to get what we can get out OUT. So far, all signs are pointing to a pretty straight-forward surgery, pending the news from the PET scan I had this morning.

Highlights of the day:

• Dr. L called me this morning to let me know that she had looked at my MRI and did not see anything remarkable, other than what we already knew. She was waiting for official results from the radiologist, but thought the MRI looked good.
• She also wanted to discuss the management of my DVT, and said that I would need to stop taking Xarelto on Thursday, and switch to Lovenox, which is the drug you have to inject into your stomach. UGH!! (Now that I think about it, I'm curious why Lovenox is okay during surgery, while Xarelto is not.) Needless to say, I'm not really happy about this, but... I'll survive (while cursing my orthopedist 1000x times over).
• I asked about the possibility of not needing to be on an anticoagulant anymore, given that my last ultrasound looked pretty good. So Dr. L pulled up the ultrasound results from February and read them aloud to me, and they actually didn't sound that good, lol. I was about to say, 'Okay, never mind,' when she said, 'Yup, sorry, not a good idea.' (Did I mention that I am cursing my orthopedist 1000x over?) (Also, the fact that he told me it was okay to stop taking Xarelto in October, and now a second doctor has told me it's not safe for me to stop SEVEN MONTHS LATER, makes me want to write a formal letter and complain about him. Seriously! But fortunately for him, I don't have the time.)
• After our conversation this morning, Dr. L sent me two e-mails - one with the official results from the MRI and one with more test results from my biopsy, showing that the tumor is negative for HER2, which is a good thing, since HER2 positive tumors tend to be more aggressive and are more likely to come back. The only potentially concerning thing about the MRI results - and I sort of knew this already - is that the tumor is right up against my chest wall. According to the report: This lesion abuts but does not definitely invade the left pectoral muscle in this region. So it doesn't necessarily spread into the muscle, but it also doesn't necessarily NOT spread into the muscle, either. And of course, there are still the PET scan results to shed more light on this. So we wait.
• Speaking of the PET scan, it was uneventful. It wasn't actually too bad compared to some of the other things I've experienced in the past month, except that it took two hours. First, I got injected with radioactive glucose and had to sit for an hour while the glucose spread. I got a lot of grading done, though, so it actually worked out well. Then the scan itself took about 45 minutes, but it was very peaceful and quiet compared to an MRI, and I was able to take a power nap.
• After the PET scan, I rushed home to relieve my husband so he could get to a lunch meeting. Both kids were home sick today (when it rains, it pours) although thankfully they both seemed fine this evening. I leaned heavily upon the electronic babysitter and let them watch movies for several hours straight, while I had a grading marathon. I got my first set of exams graded, which was a relief. One down, two to go.
• In the afternoon, my husband took my daughter to the orthodontist, my mom came to watch my son, and I went to see a genetic counselor, Melanie. I feel sort of bad because I've been super crabby with this woman, mostly just because I'm super crabby in general these days. The appointment didn't start off well when she asked me what I hoped to get out of it, and I just stared at her. Seriously, I had no idea. And I was too tired to even make something up, so I said in a fairly pissy voice that I had no clue why I was even there. Poor woman.
• However, I think I redeemed myself. Once we got going, the meeting was actually good and fairly informative. Melanie really didn't tell me much that I didn't know, but it was interesting to talk about genetics in a clinical rather than academic context. If nothing else, it will give me some good material for the cancer lecture I give my class. LOL.
• We also had a rather deep discussion about the usefulness, or lack thereof, of genetic testing in the absence of a family history. In the end, I agreed to do a full genetic analysis, which means that I will be tested for 29 different mutations known to be associated with breast and ovarian cancer. These range from BRCA1 and BRCA2 to fairly insignificant mutations that increase the risk of cancer, like, 1%. However, Melanie explained that having the results might be useful in the future, as more discoveries were made about certain genes. She also said that it might not be as easy to get tested in the future in terms of insurance coverage. The way it works now is that if you qualify to be tested for the 'high risk' genes, you can basically tack on the full analysis for no additional charge. Insurance won't actually cover the full analysis, but the labs don't charge you for it. So... why not? I guess? I also signed a form allowing my results to be used for research purposes, so hopefully that makes the $5,000 worth of tests that the lab does free of charge worth it. (You have to figure there has to be something in it for them.)
• Out of curiosity, I asked Melanie what the criteria were for insurance to cover genetic testing. She said that for breast cancer, anyone who is 40 or younger automatically qualifies. Anyone who is 50 or younger and had/has an immediate family member with breast cancer also qualifies. Then she said there were other ways to qualify as well; for example, if you have a tumor that is negative for estrogen sensitivity, progesterone sensitivity, and HER2, that qualifies you. All in all, it was a fairly interesting conversation, and hopefully I left her with a better impression than I'm sure she began with. I'm sure she was DREADING this meeting after our initial conversations on the phone.

I think that about covers it. I hope I didn't miss any important points, but I can't make any guarantees. I'm in full-fledged survival mode. Thank you all for your comments, e-mails, texts, etc., and thank you, C, for dinner tonight! I'm on a $12/month cell phone plan because I normally don't use my cell phone very much, but I've been getting notifications all night that my account has 'insufficient funds.' I need to figure out how to upgrade my plan now that my doctor and all these medical people have been calling me 10x a day, and I've been getting tons of texts. Maybe upgrading my plan and getting a smart phone will be 'surviving cancer' treat to myself.