Meeting with Medical Oncologist #2

I had a meeting with Dr. M, medical oncologist #2, this morning. I liked him a lot better than Dr. U, and so did my husband. So, for now, he's a keeper. The thing is that he really didn't say anything very different than Dr. U, but I felt more comfortable and at ease with him, like he was someone I could talk to very easily. He was also funny. Not in a HAHA YOU ARE SOOOOO FUNNY! slapstick kind of way, but in a subtle way, which I can relate to. Aaaaand, he was a huge nerd, which I have to admit I sort of love. He actually asked me right off the bat what I did as far as work, and was excited that I teach biology so that he could talk 'higher level science' with me. And his dad worked his whole life for the same company my husband works for, so he 'gets' us. That said, he explained everything very thoroughly, and doodled as he explained everything.

As predicted, he said we would have to wait for the results of the oncotype before deciding on chemo vs. no chemo. However, he did a broad overview of all of the options, and said that as far as cancer goes, there are four basic questions and answers he likes to cover with patients, even if they seem overly simple. These questions are:

1. What type of cancer is it?

2. Where is the cancer?

While most people have heard of Stage I, II, III, and IV, the way the stage is determined is by the TNM system, where T is for tumor size, N is for lymph nodes, and M is for metastasis. 

3. What treatment should we do?

For breast cancer, there are of course two surgical options: mastectomy or lumpectomy. Since I opted for lumpectomy, or 'breast preservation surgery,' I will almost definitely benefit from radiation therapy. We briefly discussed that I would need a radiation oncologist, and the fact that there were only a few in town; however, Dr. M said the radiation would be very straight-forward, and any of the radiation oncologists or facilities would be just fine.

Along with radiation, some sort of anti-hormone therapy is pretty much a given as well. Since I am pre-menopausal, the only real option is tamoxifen. Dr. M explained that tamoxifen was a type of drug called a SERM, or Selective Estrogen Receptor Modulator. A lot of people think it is an estrogen blocker, and it is, but only in breast tissue. Because there are different estrogen receptors in various parts of the body, tamoxifen actually increases the effects of estrogen in other parts of the body such as the bones and uterus, which makes me sort of nervous considering my uterus was 'suspicious' on my PET scan. (I feel a hysterectomy in my future.) He also added that the way estrogen works is that it binds to estrogen receptors, which once activated serve as transcription factors; in other words, estrogen exerts its effects by changing gene expression. (I could tell he was really excited to tell me this, since he knew I would understand. And of course, I came home and immediately Googled estrogen receptors to learn more. For example: http://physrev.physiology.org/content/87/3/905.)

We then had a discussion about my DVT and the fact that one side effect of tamoxifen is increased risk for blood clotting. Surprisingly, once I explained the development of my DVT, Dr. M said he would not have a problem with me being on tamoxifen and a prophylactic dose of daily aspirin. He said that post-surgical DVT was a 'reversible risk factor' and not the same as DVT out of the blue. However, he would defer to my primary care physician. This is good news, though, because I was sort of imagining either being on Xarelto for the rest of my life, or getting forced into having my ovaries removed before I was ready because I would not be able to take tamoxifen. I know this situation merits further consideration and probably some follow-up tests (e.g., a fourth leg ultrasound), but I am just as willing to trust Dr. M as I am my PCP, seeing as how Dr. M is board certified in hematology.

Speaking of ovaries, Dr. M did say that in two major studies, a certain subset of women who were pre-menopausal, but opted to have their ovaries either removed or medically shut down, fared better than pre-menopausal women on tamoxifen. However, he didn't seem nearly as anxious to kill my ovaries as Dr. U. He also asked if we were done having kids, and when we said yes, he asked whether we were SURE, because that was an important consideration. I find it interesting he is the first doctor to bring this up. I never really considered the importance of doctors discussing this with me, because I knew that I was done having kids, plus, I am 40... which is young to have breast cancer but old to be having kids. So that was our discussion about anti-hormone therapy.

Dr. M said we didn't need to discuss targeted therapy, because for breast cancer this would mean Herceptin for a HER2 positive tumor, but my tumor is HER2 negative.

Of course, chemotherapy is the big question mark, and obviously depends on the oncotype (more on this below).

4. What is the prognosis?

Very generally speaking, there is about an 80% chance that in 10 years I'll be alive and cancer-free, assuming, of course, that nothing else kills me (like this damn cough). The chance of recurrence is around 20%, and radiation will reduce that by around 50%, down to about 10%. The weird thing is that 80% sounds very high, but so does 20%. As I tell my class when we do genetics problems, a 25% chance of something happening sounds a lot higher when it is your child and a deadly disease you are talking about. I guess the same goes for when it is you and it is breast cancer.

Dr. M explained the stats by saying, 'There is an 80% chance that all of the time you spend with me and that everything we do will be an unnecessary waste of time.' LOL. He compared it to a measles vaccination, asking me if I had been vaccinated against the measles. I said yes, and he asked if the vaccination had worked. I replied that so far it seemed to have worked, seeing as how I've never had measles. Then he said, 'Either the vaccine worked, or you've never been exposed to the measles, and the vaccine was just a waste of time.' He then went on to say that the whole basis behind the anti-vaxxer movement was risk vs. chance of exposure: some parents don't want to subject their kids to potential toxins to protect them against something they have very little chance of being exposed to. Then he eyed us questioningly and said, 'Perhaps that's you...?' I shook my head vigorously and assured him that wasn't us. Then he replied, with relief in his voice, 'Okay, just checking! We are in State With A Lot Of Crunchy Types, after all.' The point is that with radiation, it's likely we could bring the odds of no recurrence up to 90%, which is significant. The question is what, if anything, we want to do with that final 10%.

Dr. M had his MA check on the the oncotype results. Apparently the lab had just received the sample and said the results would likely be available by Friday, June 5th. However, he explained in general terms that the results would be numerical, which I knew, thanks to my new favorite web site breastcancer.org. A low-risk score is under 18, whereas a high-risk score is over 32. He repeated what Dr. L had said, that it was the in-between part that is hard, because there are no data to guide treatment decisions in this range. It's literally a crap shoot; in this range, things have to be decided based on gut feelings, and that is not easy. Then he added jokingly, 'With my luck, you'll probably come out in between.' LOL. His luck? What about my luck? According to my orthopedist, there is a 1% chance of developing DVT post hip arthroscopy, yet I managed! Though admittedly, I'd be much happier with an in-between score than a high score regardless of how difficult the ambiguity might be.

Dr. M did go on to say that although the cancer did not appear to be a super aggressive type, we had to be somewhat careful. He said that there was a big and statistically relevant difference between pre-menopausal vs. post-menopausal cancers. They behave differently. Pre-menopausal cancer is more aggressive, for reasons that are not well understood. Not only is the cancer more likely to recur, but it is also more likely to metastasize, meaning there is a risk it won't come back in my breast, but rather, in my uterus or bones or liver. So yearly mammograms (which I swear I will do from now on) won't necessarily cut it. For cancer at 40, you should add one degree of severity. This was actually sort of sobering news, so I didn't ask for more specifics. Come to think of it, Dr. M was sort of more gloom and doom than Dr. U, but somehow, despite the fact that he did not sugar coat anything, he managed to not make it sound awful. At least, I didn't leave feeling like I wanted to slit my wrists (though I sort of do now, haha).

Finally, I asked him what his thoughts were on working while receiving chemo and/or radiation therapy, simply because the nature of my job would require me to give a significant amount of notice (not from a legal standpoint, but from a conscientious professional standpoint). He said it really depended; if you break rocks for a living, it's going to be harder than if you sit at a desk all day. He asked what I did, then added, 'I mean, I know you teach, but what is your day like?' I said when I wasn't teaching, I was usually sitting at my desk. He asked me how many courses I taught per semester, and when I told him four, his jaw dropped. This made me like him. Only people who have actually taught a college course before get that four courses is a lot. Yes, I have flexibility, but it's not like I sit around all day twiddling my thumbs. Apparently he taught a college course one time, and said it was a lot of work - 'too much for me.' LOL. Anyway, he said it really depended, and he couldn't make that call, but he always supported his patients' decisions - if they needed documentation for medical leave or whatever, he would provide it. He also said that the drug he had in mind for chemo, if I did chemo, would make my hair fall out (boo :( ) but was not as brutal as other drugs in terms of side effects like fatigue and nausea. It would hypothetically be possible to work through it, if I wanted to/needed to. However, I've pretty much decided that if I have to do chemo, I am not going to subject myself to the toxicity of my work environment - with my super stressful colleagues/students and hundreds of sick people all around me - while I am already having to go through hell. It's bad enough I have a permanent limp, and now I'm supposed to teach with no hair? WTF? LOL. Radiation is different, however, and I have read mixed things about working through radiation therapy. While I do have a strong desire for things to stay as normal as possible, and not let cancer take over my life, I also need to be realistic about the fact that this is going to take a toll on me, especially considering my ridiculously low stress threshold.

The whole appointment took about an hour from start to finish, including a quick physical exam. Dr. M sort of made me laugh by asking me if it was okay if he checked my breasts - as if I am going to see a doctor for breast cancer that I won't allow to see or touch my breasts. As we were leaving, he asked if I wanted something for my cough, and I said YES!!! so he gave me a prescription for the heavy-duty cough medicine that knocks you out, so I'm hopeful I might be able to get some sleep tonight. The people at the pharmacy probably thought I was going way overboard seeing an oncologist for a cough. LOL.

All in all, it was a good appointment, though not highly informative, but at least that was expected. I left with a much better impression of Dr. M than Dr. U, so that is a relief. It's hard to know what to expect from an oncologist; like so much of this experience, you only know when you like or don't like something once you've encountered it. Do you want someone to smile when they deliver bad news, or act all gloomy, or show no emotion at all? It's hard to say. You just know it's right when it is right. And so far, it feels right.

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.