Wow...big mistake!

So today I went for my third exansion and so far, this was the biggest.  I feel very tight but the girls are looking pretty good...if I do say so myself.  I took a heavier dose of valium to loosen the muscles and some ibuprofen and slept a little after lunch.  I relaxed the rest of the day since we walked over to the doctor on the snowy roads and it was still cold so I was a little unsteady.


Later this evening, I asked my sister if she wanted a picture text of how the boobs were turning out since she will be getting her mastectomy in January and she has seen rahter frightening pictures of mastectomies.  Her phone did not accept picture messages so she asked me to send it over to her husband's phone.  "Alright", I agreed, "But you have to immediately delete it because I don't want him to see the picture of my breasts."  I thought it would be kind of creepy.  So she texts me his number.


Since I am a constant multi-tasker, I was doing something and I memorized the number to send the picture...or so I thought.  I sent over the headless text of my breasts..and asked my sister if she received it.  Nope.  So I send it again.  I then waited a few minutes and then texted her to see what she thought.  Hmmmm....she STILL didn't get it.  All of a sudden there was silence.  She texted me back.  "What happened if you sent them to a random number?" she texted.  Please God no!


I looked a the number she texted and sure enough I mixed up the 4 and the 9's.  Can you just imagine what that person is thinking right now?  Who the heck from SF is sending me naked boobie pictures????  WHAT are the odds?

Belated Holiday Greetings

Merry Christmas and Happy Holidays!  I am sorry I have been a little lax in writing.  I will tell you that I got a bit cocky.  Well,.....too cocky in fact!  I went for my third expansion on Thursday and my plastic surgeon decided that I was a bit too bruised and we were going a bit too fast.  Therefore, the stitches were taken out but no saline expansion occured.  I have to add that I weaned myself off of the valium and ibuprofen and was feeling really great about everything.  I was healing; the soreness was minimal and it was almost Christmas.  Since we drove over to Dr. Bucky's office on the Main Line which was near my in-laws, we decided to continue driving so that we could see his brother's family that were visitng his parents from Miami, Alaska, Maine and NYC.  En route, I received a text from one of my fellow master's students who took a job at a boutique dress store.  I figured since I was feeling, oh so fantastic, why not stop in and try on new clothes since they were having this amazing sale on all of these one of a kind gorgeous designer items.


No problemo.  I was in there (in my surgical bra) trying on about 12 different dresses and having a great time.  I bought a few things, hopped in the car with my husband and continued over to my in-laws for dinner.  At this point, I will interject and point out that my in-laws embrace the custom of cocktail hour...every night.  It is presented as it was in the 1960's which is complete with beautiful crystal glasses, petit and flavorful h'or doeuvres while sitting around the fireplace chatting about the day.  Since I was feeling like I never had an operation a mere ten days ago and I declared myself free of valium, I decided that I would allow myself one glass of pinot grigio.  Afterwards, dinner was served which was a venison stew brought down from Alaska by my neice and her boyfriend and then we decided to drive back fairly early.  Great day, right?


By midnight, my chest felt like it was wrapped with a sheet of heavy armour and I could barely breath.  If I had that morphine drip like I did in the hospital, I would have been pumping that baby till there was no tomorrow.  Since I am still scared to take the Dilaudid (and I will not do it), I threw back some valium and about four ibuprofen.  Sleep..finally..at least for a few hours.  Next morning, I needed Bob to help me get up and out of bed.  I wobbled to the bathroom and decided, screw it, I am staying in my fleece PJ's all day and taking my trusty and new best friend, Val, with an occasional ibuprofen here and there if needed.  Back to watching Married to Rock (are these women for real?) and The Housewives of Beverly Hills (train wreck!).  I couldn't even wean myself onto a movie since I needed stupid valium induced reality TV shows to forget the sheet of armour around my chest area.


So now it is Sunday.  Christmas?  What happened to that?  I made it into a shower and out to a movie (How Do You Know?) yesterday which was adorable by the way.  We had to see that movie since they filmed a tiny part in our condo unit last year and the producer and her family lived in our condo for two months and paid us a lot of money for us to leave.  I figured it was a cute chick flick that would be perfect for a non-thinking movie where I could sit straight up and reduce the straight-jacket effect of the armour.  I thought long and hard about getting out of those fleece pants though....but I did...AND I put on makeup and perfume!  Just doing that makes me feel human :)


Today, I am doing much better.  The armour has subsided and feels more like an Ace bandage which has taught me a few things.  First, don't get so cocky and think that you are superwoman and can just breeze through the healing process.  Second, Val is your best friend and is used for a reason which is to relax the muscles so that they can heal.  Finally, a walk outside in the snow or cold provided that it is a little walk and not 25 blocks in the city is good for your psyche.  Oh yes,  and although there is a great sale......put it off since the clothes might still be there in a few days PLUS it is not easy getting in and out of all of those dresses, pants and shirts by yourself.


So, on that note, I am going to take my fleece robed body, drop another valium, put on earphones and read for a little bit before I lapse into a long nap.  I have been informed that my husband will be waking me up for another quick little walk into the fresh air so that I my ass does not become a permanent part of the sofa.  Let's see how I do for New Year's :)

Lymphatic Drainage Massage

Yesterday I had my first lymphatic drainage massage.  The method used was the Vodder method.  The mthod was established in the 1970's by Dr. Vodder and is practiced throughout the world.  It specializes in lymphatic drainage and is used quite extensively for mastectomy patients during the healing process to move the lymphatic fluid and provide more mobility.  The expanders that are in place to stretch the muscle under the skin to accomodate the implants are a bitch.  Sorry, but that is the best way to describe them.  Obviously, their job is to stretch out a muscle that does not want to be stretched so it is constantly fighting back the expansion.  Today, I will receive my third expansion since I am trying desperately to get as much done before the move which occurs in about ten days.When I told my firend that I was leaving to get my massage, her reply was "How nice! I haven't had a massage in awhile."  Well, my friend, it is not a Swedish massage in a room filled with lavender candles with lights dimmed really low.  This one has a purpose which is to provide more mobility and less soreness by moving the fluid inside the affected area.  There was no pain involved and basically, Dan just worked the breast tissue.  For any guy reading this, they are probably thinking....wow..how cool is that...massaging women's breasts!  Great benfits plus the pay is good!  But seriously, Dan has been doing this for years and I am sure he has seen it all so the breasts are basically non-issues.I was lucky in my surgery to not have to have any lymph nodes removed which hinders the mobility of my arms.  I can raise them quite high but there is a definite soreness above, say, elbow to eye level.  When Dan was finished, I could raise them almost over my head without any soreness.  I have already arranged to have a lymphatic drainage masseuse in Savannah to continue the process since I truly belieive in the body's natural healing abilities.  I am also happy to say that I am off all pills.  I do, however, keep my happy little valium pill close by just in case :)

Drains out while boredom sets in

I am most certainly on the fast track for getting the expanders out and the implants in.  To give you an idea of a "normal" timeline, the operation would take place and then two weeks would pass when the first expansion would then occur.  Two more weeks would pass and then another expansion and so on until the appropriate size was met.  Then a period of "down time" would occur so that the muscles could acclimate themselves to the new position; then, wa la...expanders would be echanged for implants in an outpatient operation.


Since Dr. Bucky is trying to accomodate me before I move out of state, we have been on the accelerated program.  Yesterday has been one week since I had the operation and, as of yesterday, I have had two expansions.  They do not hurt.  It just feels like heavy pressure against your breast bone while the saline injection is pushing the muscle outward.  I was probably most thankful for the two drains that were attached to the tubing under my armpits that were finally removed.  Those, my friend, were torture.  First of all, you feel like Frankenstein with electrodes hanging out of your body and then you have to figure out where to hide those dangly things.  Although I have to admit, the farthest I ever got was from the downstairs kitshen to the upstairs bedroom and, on occassion, to the doctors office hidden in a huge coat so it didn't matter too much but it sure was a bit painful.  But, yeah!...they are now gone and good riddence!


So my day consists of sitting and watching stupid TV shows like The Housewives of Beverly Hills and Wedding Makeover shows.  I cannot believe that I actually sat and watched 3 episodes back to back of these spoiled, trampy women and could not tear myself away from the TV.  So that's it!  No TV at all today.  I will be reading instead and then, maybe, I will allow myself a show after 7 pm.  My brain will turn to mush pretty soon and I will never be able to hold an intelligent conversation ever again.  I feel better with an ocassional twinge of pain here and there but my brother, who has had many opertions in his lifetime, told me that no matter how good you feel at the moment, do not do anything because your body is still healing and you will set yourself backwards.  I am taking that advice to heart.


Tomorrow, I have another possible expansion after I get my lymphatic massage.  My sister-in-law had a breast enhancement last year and had used a lymphatic drainage massage specialist for a few months afterwards and she swore by him.  It helps release the lymphatic fluid and helps to keep the "girls" soft and subtle.  My doctor told me that when you look at women with boob jobs and they have that strong ridge on the top near their clavicle, the main reason is that there is a lot of scar tissue and it hardens.  Massages help enormously in breaking down the scar tissue.  I already found a masseuse in Savannah to continue this routine since I want to appear as natural as possible.  I will let you know how it goes tomorrow.  Right now, I will head back to my chair and grab my new book that I have not even opened and hide the TV remote control and try really hard not to eat any more Christmas candies.

Pump up the volume

Imagine that you have a hard apparatus placed under your muscle with a tiny little tube that allows saline to be pumped inside to expand it to make it larger.  Well, I went in on Friday for my first expansion and it was neither pleasant nor unpleasant.  It just felt like more pressure was added and my breasts began to take shape.  In fact, I really wasn't planning on going for porn star status but, I figured, if I am going to endure this soreness, I think I've got to go for a nice looking rack...don't you think? 


I've been doing really well staying away from the heavy duty drugs like Diludid and have only been taking Ibuprofen, Valium and an anti-biotic.  You see I hate drugs.  I have seen them ruin people's lives and I refuse to let some synthetic pill take over my mind.  I like natural alternatives and the prune juice took care of the "other" issue at hand from the anaesthesia.  Plus Nurse Bob has been blending fruit drinks with protein additives with a bagel here and there for carbs.  I do have to add that Gayle and Grady sent over the largest tin of See's candies comprised of nuts and chews so my healthy diet has been shot all to hell.  Love you guys for that!
I go back tomorrow for more saline since I am on the fast track program.  Remember I am moving shortly and Dr. Bucky is going on vacation over the holidays.  I am also set up for a lymphatic massage which is supposed to be a natural healing alternative.  My first one takes place on Wednesday and I found someone in Savannah to continue the massages once I get there.  I have almost full mobility of my arms which enables me to wash my now very short hair and take showers.  I think it was because I did not have any lymphnodes taken out.  I still don't feel steady enough to go outside for a walk but that is on my list to do before Tuesday.  I have to set goals :)  So, all in all, it hasn't been even one week and, although I am uncomfortable, I can manage which is encouraging.  I think all of your prayers have greatly helped so thank you all.

Save the Nips

I am completely surprised at how easy this ordeal was.  I am saying "easy" because it is all relative.  There was never a moment of intense crying out pain; it was more like a soreness from brusing or from pressure where the expanders are placed under the muscle.  I asked the PS why I couldn't get the implants in directly and he said they didn't look right which, in my opinion, was the correct answer.  I told him my criteria was pretty boobies and bigger than what existed.  He definitely heard me loud and clear.
I think I was under for 4 1/2 hours but what do I know.  I was blissfully asleep and then was rolled into my room which was so quiet.  I started taking the morphine drip but then I got scared that I was going to vomit so I kept it at a minimum.  I refused to take the valium at night too.  When I woke up in the morning my chest started to have muscle spasms so I started to breath like pregnant ladies do.  I don't have kids but I watched enough TV to get the idea and it did help.  When both doctors scolded me for not taking the drugs, I started to take them.  The reason to take them is because it relaxes the muscles and they need to be relaxed so they can expand it further to accomodate the implants.  Ok...I gave in.  I just hate drugs so I had a hard time with using them.  I had a cathater in during the operation and I wanted that thing out as soon as possible.  Ooooooooh! not a pleasant experience but it was out by midnight.
This may be TMI but I hve to tell you that I was given a bedpan to try to pee in bed.  Yeah right?  All your life your parents train you to not pee in your bed.  So here I sit trying to pee in a horizontal position.  No way in hell!  My mind was telling my bladder, "Get up and out of bed you lazy ass and pee in the toilet where you are supposed to go."  It was a bit of a struggle but my mind won over my bladder.  That was the only time I felt dizzy...walking to the bathroom.
The other annoying sorenes is where they place the drainage tubes which is under your armpits so you have to sleep or sit face up.  After awhiile, you back hurts frm staying in that one posisiton.  I sat in a chair for awhile and it felt better.  Overall, I stayed at the hospital for two nighs and it was fairly quiet and the nurses were very sweet.  I love Penn Hospital.
Today at 4, I see the PS since my nipples have turned black which is not a good sign.  They may be dying but he thinks he can save them.  This is now my new battlecry...."Sae The Nips"!  I will fill you in later on the outcome.

Back Home

I will do my best to write a little but then I need to sleep due to all of this valium.  But when I awaken, I will post further.  Monday (B Day), I went to get marked at the plastic surgeons office so I looked a little like those idiots on Extreme Makeover with magic marker on their breast, noses, tummies, you name it.   My markings were only on my breasts.  I did however, try to get a two for one deal for the little fat pockets under my armpits that tends to show itself after 45.  No go on that...but I tried!  I was then dropped off at 9:30 to pre-op at Penn Hospital but waited and waited untl about 1:30 to go under.  Both doctors had operations beforehand so I guess they ran late.  i remember nothing except waking up and looking at the clock in the post op room which said 6.  I dozed back again and then woke up in my room where the clock read 8 pm.  Wow...long day!

B- Day @@

I am up with T minus two hours to go before surgery.  I think I am ready.  I still have to take a shower but no food or water since 8 pm last night.  I am not anxious or nervous which is good.  I have to say I now know what a pregnant woman goes through before she gives birth and readies her house before the baby arrives.  Yesterday, I vaccuumed and cleaned till I was exhausted!  I folded the duvet covers and needlepoint rugs and packed those away neatly into the moving boxes so that they wouldn't just be thrown in at a later date. Afterwards, I went to community.breastcancer.org and read up on my December mastectomy "buddies" and got an idea of how they are recovering days after surgery.  What a wonderful website as well as an inofrmative virtual community.  So helpful!  And then finally, I spent the rest of the day on the phone with my friends and family.  That was the most comforting of all!  It is so nice to have people call and wish you well before surgery.


I was a little disturbed on Saturday when I received a letter from the insurance carrier stating that they denied coverage..at the last minute!  Can you believe that?  Luckily, I saved the letter that arrived on Friday that stated the procedure was covered.  I looked at both dates and drew a sigh of relief.  The acceptance letter was dated two days after the denial letter so I assumed my doctor got involved and helped to over ride the denial.  Note to others......make sure all paperwork is in order before the operation or heart attack may ensue.


During my "almost" meltdown, I started thinking about the new healthcare plan if it ever gets enacted.  I wonder if a preventative mastectomy would have even been covered for an LCIS patient.  Would they have covered the mastectomy and denied the reconstructive aspect of the surgery since that would be considered cosmetic?  These are definitely things to think about if you are putting off this procedure in the near future.  Who knows what will occur if this government program goes fully into effect?  This is not an inexpensive operation.


Okay....so I am going to wear comfortable, loose pants with a button up shirt to get easily in and out of after surgery.  All I am going to bring is my healthcare card.  My next stop is to the plastic surgeon at 9 to get marked up like they do on "Extreme Makeover" and then over to the hospital for pre-op at 9:30.  The surgery should start at 11:30 and end about four hours later.  I will do my best to remember everything for you and hopefully will be back to you on Wednesday to report the experience.  Bye bye boobies :)

For Locks of Love



I woke up and decided that, yes, today was the day to donate my hair.  I donated it just two years ago and I was waiting until January 2011 to do it again.  It felt more like a milestone if I did it today- two days before the mastectomy.



After Lauren cut the ponytail, we decided that we liked the way it fell with the longer length in the front and the shorter length in the back.  Thus, my new "do" was born.

New boobies....new hair style.......what next? :)

Life Goes On

The anxiety is beginning to set in...finally.  Not that I was looking forward to it but I figured it had to happen sooner rather than later.  I think I am more anxious about the move which will occur 15 days after the surgery.  "Why?", you ask.  Well, we've packed up houses and moved SIX times since 2008!  No, I am not a gypsy..nor a vagabond.  To begin with, we had our house fall out of escrow in 2008 AFTER we had everything packed and stored off site which then had to be moved back and semi-unpacked for a year and then moved back into storage again when we rented out that house.  Then, we sold and moved our second home "stuff" from SF to Philadelphia....only to have that condo sell four months later.  A year ago, we moved the furniture from the storage unit in California to another storage unit in Philly and then finally, we took the furniture from the sold Philadelphia condo and moved it into a rental.  NOW, we have to pack the remaining furniture and store that for a year while we try out South Carolina which, thank goodness, that house is fully furnished.   If you are a woman, you know that it isn't going to get done the way you want it to get done unless you do it yourself.  Thus..the anxiety.  Today, I am giving myself a list of items to pack before Monday so that my husband is not burdened with the chore of packing and, eventually, getting scolded for not doing it the "correct" way. 
I say "life goes on" because it does.  I still have to see the dentist today and get my hair done tomorrow.  Laundry still has to get done and the house still needs to be vacuumed.  Just because I am going "under the knife" on Monday doesn't mean there will be an interuption on FOX News stating that ...."Arlene Flick has been in surgery for four hours and expects to emerge with fantastic new breasts by mid-afternoon."  It just doesn't happen that way.  Well, it doesn't happen that way unless I am Michele Obama or ......maybe Oprah.  There are far more people that are undergoing much more serious operations than this which always centers my perspective on this surgery.
Yes, it will be painful.  Yes, my body will change.  Yes, it will take weeks (perhaps months) to fully recover but I have to learn to work around it and continue living my life.  Hopefully, this will not sound contrived but we all have one shot at life...and it is short-lived.  Therefore, as painful or as frightening as new experiences are or appear, there is always the option to either A) walk away and do nothing or B) jump in feet first and wallow in it and experience it in full.  I choose "B".

B Day (Boobie Day) minus 5 days...and counting.

Five days until B Day which means I need to prepare in advance for the surgery.  I have to admit that I am not much of a "planner".  I consider myself an "organizer".  In other words, the planner anticipates what is needed in advance while the organizer establishes systems and reduces chaos.  My mother, sister, neice and brother were (or still are) teachers which means they are the ultimate planners.  I remember watching my mom write lesson plans for her classroom weeks in advance and create lists for grocery shopping.  I am definitely NOT that person.  I hate the thought of packing for a trip.  Seriously, I usually do it a few hours before I leave with the thought that I could always purchase something if I needed it at my destination.  I came to this realization on a home building trip in 1997 with my church to Tijuana.  I remember that I forgot something along the way and, even in an impoverished region, there is always a place to purchase whatever you need.  In fact, I think there may even have been a Walmart close by.  Truly globalization at its best!

There is a link that I placed on this blog to www.community.breastcancer.org which holds forums for all topics including diagnosis,what to do once diagnosed, surgery before and after, etc..  If I was a true "planner", I would arrive at that hospital with two suitcases in hand filled with all the essential items that have been recommended on this site.  It is a very comprehensive list.  However, I am NOT that person.  I am happy to say that I did purchase two items that I deemed necessary- white comfy fleece pants printed with pine trees (in celebration of the Christmas season) and a royal blue fleece vest since the drains will be located under my arms and I will need easy access.  I actually am pretty proud of myself for doing even that!

This past week, I had an appointment with one of the nurses from the plastic surgeon's office to go over what will occur on Monday.  It seems that both the breast surgeon and plastic surgeon have morning surgeries so I will be in the afternoon.  First thoughts? What if they get tired after lunch and don't do a good job?  I know I always morph into a "food-a-coma" after eating but my occupation did not wield a knife- only a measuring tape for carpet.  I was assured that this would not be the case.I cannot eat after midnight on Sunday so I may be a bit hungry but, hey, I was planning on losing at least five pounds, with the hope of ten, throughtout this ordeal.  I will need to drive to a different office where the plastic surgeon will be in the morning to get "marked" and then arrive at the hospital to get prepared for surgery.  The breast surgeon's part will take approximately two hours and then Dr. Bucky will step in and go further under the pectoral muscle to either 1) insert implants directly into place or 2) place the expanders into place.  The hope is that the implants will be used in lieu of the expanders.  This would alleviate a lot of future discomfort and reduce the amount of time that we will be driving back and forth from South Carolina in the future.  If the expanders must be used, saline is injected at different intervals to expand the muscle to accomodate the implants at a later date.  Kind of like blowing up a balloon.  However, I am not shooting for a  large "C" (to my husband's dismay) so I hope I can forgo this step.  My criteria for Dr. Bucky is to create breasts that are larger than what I have now but to look as natural as possible.

4 for 1

I just found out that my only sister was diagnosed today with LCIS after a biopsy was done last week.  Hmmm...can we get four boobies replaced for the price of one?

That's What Friends Are For

Interestingly enough, my decision had been made to proceed with the preventative mastectomy but it seems that not everyone was on board with me.  The most important person, besides myself, that I needed to affirm this decision was my husband.  Thank goodness Bob was in agreement.  I think it helped that I dragged him to the first oncologist meeting at which the doctor said that he agreed with a preventative mastectomy if my risk was going to be substantially reduced.
I wanted to post a few comments from my friends so that those of you who are considering a a BPMX(cancer lingo for bi-lateral preventative mastectomy) will understand that it truly is up to you to make that decision.  I have decided that human beings, for the most part, need to assert their opinions because they want to be heard.  It makes us feel acknowledged.  This blog, in fact, is my way of being heard and makes me feel like my voice counts.  So, keeping that thought in mind, here are some of the comments that I experienced when I told some people that I was thinking about a BPMX:
"LCIS is not cancer so why would you cut off your breasts?"
"You said that you don't like to take drugs (tamoxifin) but yet you would cut off your boobs?"
"If you just think positive thoughts, this will not manifest itself into breast cancer."
"I feel there is a black cloud over your head and I don't have a good feeling about this surgery."
"Breasts are so important to me that I would NEVER do such a thing."
"There's just got to be something else you can do."
Those are some of the negative comments.  However, these were some of the positive comments:
"Honey, I am so proud of you for doing this." (from my 83 year old dad. Love you dad!)
"A preventative strike, as physically and emotionally painful as it will be, is ultimately a kindness to your body; the ravages of surgery, chemo and radiation are so much worse."
"You have a lot of courage to do this and my prayers are with you."
"Knowing what a good student you were that you probably got A's and would be disappointed with getting Bs and Cs. With the new boobs you can be excited about getting C or D, I guess that might be a bit big but D's are good in you want to get in adult movies." (one of my favorites from an old college friend)
"You can still feel "down there" right?  Well then, who needs boobs anyhow?" (Loved this!)
I am grateful that I have a lot of friends scattered throughout the world and I am thankful that Facebook has helped me to connect with people that I haven't seen or spoken to in ages.  It is so comforting to know that there are so many good, kind people that offered to help during this time period  I will just say this to all of you.......I appreciate all of your prayers, thoughts and emails.  They give me the affirmation and strength to continue this journey.  I thank you all!

The Bucky Nipple

Since I am a very linear person, I will postpone my post regarding my pre-op check in with the plastic surgeon yesterday and concentrate instead on completing the decision process.  After the research, meeting the oncologists and taking/not taking the BRCA 1/2 test, I decided it made sense to speak with the plastic surgeon.  Immediately, I called my breast surgeon's office and they recommended two surgeons that they collaborate with for breast reconstruction.  I looked both up on the internet.  Seriously, what did we do before Google? 
The first doctor specializes in tram flap reconstruction.  "What is that?", you ask.  The tram flap procedure uses muscle, fat and skin from one's abdomen to create a new artificial breast. The advantages include the use of non-synthetic materials and the patient would get a tummy tuck in the process. The disadvantage is the longer recovery time and multiple scarring since it is a more extensive surgical procedure.  My thoughts on this?  Bring on the silicone!
I made an appointment with the other plastic surgeon but, since he is very well known in the Philadelphia area, I had to wait a few weeks.  The receptionist tried to get me in earlier since I am on a timeline.  Sorry......I failed to disclose to you that this all took place in November 2010 and we are going to be moving from Philadelphia to Bluffton, South Carolina on January 4, 2011.  Normally, the breast surgery and reconstruction take place over a 3-month time period so, if I proceed with this, I am trying to get the first month, which is mainly recovery, completed before the move knowing full well that Hwy 95 will become my new BFF in the future.  After a few mix ups on both his and my part, Dr. Bucky and I were able to meet at his office.
This may sound superficial to some, but to me, aesthetics are very important- especially good decor.  When I walked into the reception area, the lighting was perfect and the colors were warm and inviting.  Both the nurses, as well as the patients waiting to be seen, were attractive and well coiffed.  I mean, think about it.  A plastic surgeon, for the most part, is selling youth and sexiness, right?  Not only do I want an experienced, competant surgeon but I want to know that I will look beautiful and as natural as possible when I get done with this ordeal.  Since this decision is "preventative" and not mandatory, I needed to get a sense of what I was going to look like afterwards in terms of scars and overall breast appearance.
After doning a warm (loved that) salmon colored waffle-weave "gown", Dr. Bucky and I sat down for a consultation.  Let me interject here to say that I am a textile graduate and former colorist so colors and fabrics are important to me.  If I get very tactile in description, you now know the reason behind it.  Anyway, the doctor went through a list of criteria that makes a mastectomy easier in terms of recovery and also recreating or enhancing the overall look of the breasts upon completion.  Out of all 7, I scored an "A" (if you know me at all, you know how I love to score 100% ).  I only remember 2 of the 7 which were small breast area and thin/good health.  So FINALLY, after all these years of exercising and hating my smaller breasts, it worked in my favor!
Together, we looked at past patients that had similar body types in terms of before and after pictures.  The scaring was minimal and, in some, the breast actually looked "prettier" afterwards.  Even in those patients that needed reconstructed nipples, Dr. Bucky was pure artist.  Seriously....he dubbed it "the Bucky nipple" and it was amazing!  Although I am a candidate for a nipple saving procedure, I felt so confident after meeting him that I actually had a skip in my step on the walk home.  I was told that the expanders were not going to be a "walk in the park" and I will lose feeling in both breasts but  I knew that from talking to women who went through mastectomies.  My main concern was that I will look normal.  I feel extremely confident that Dr. Bucky will achieve this goal.  I now made the decision to go full steam ahead and contacted my breast surgeon to get the ball rolling!

Hello Gene!

If you are not familiar with the BRCA 1 and 2 gene, let me educate you. These human genes, when mutated, are linked to breast and ovarian cancer. Harmful mutations in the BReast CAncer 1 and 2 genes can be found via a simple blood test but it is quite expensive (about $3500) if not covered by insurance. The gene can be found in those with a family history of breast or ovarian cancer and those of European Jewish background. The risk factor of those with the gene is five times more likely to have cancer than those without the gene.
I was introduced to this gene (Hello gene) while living in the SF Bay area through my health care provider- Kaiser Permanente. If you opted to have the test taken, a mandatory two hour class explaining the gene and also what you need to think about if you found the gene was necessary before you opted to pay for the test. I attended the class and I found that, in my case, the test would not have been applicable since my "control" (my mother) was not alive to test to see if she had the gene. It is better to test someone with breast cancer first so that it would be easier to locate the gene in the next generation. I opted to not spend the money.
A year and a half later, circumstances have now changed since LCIS was discovered in my right breast. I decided to meet with a genetic counselor from Penn Hospital. Let me say, at this point that, damn, I am lucky to be in such an amazing city with so many teaching hospitals. For as much as I made fun of Philadelphia for the past year and a half, I have to say the medical facilities are top notch. Not only was Pennsylvania Hospital our nation's first hospital (1751) but University of Pennsylvania took it over in 1997 which elevated their resources and staff to a new level of care. I chose it not only because I can walk to the hospital but also because it was ranked so high.
I was given a very extensive survey to complete before I met with the genetic counselor and an oncologist to take the test. When I mean extensive, I am not kidding around! My mom was an only child and my dad has one sister, who ironically has battled breast cancer in her 70's and now is battling lung cancer. Since I forgot a lot of my history, I contacted my aunt and she helped me fill out the paperwork in terms of who died of what and when. Both she and my cousin have incredible memories! Goodness, I can't even tell you what I ate yesterday and they knew the months and year of when my mother's father died. He wasn't even on their side of the family! Another positive outcome from this was that I was able to ask my aunt questions about her own personal battle with breast cancer. She and I have different opinions but it was so interesting to listen to her thought process and how she managed to deal with everything. She also put me in touch with a friend of a distant relative who went through a double reconstructive mastectomy for me to interview at a later date. (future post)
The day finally came and I was ready to meet with the counselor to take the test. She had the paperwork beforehand and she drew up a chart and calculated the probability of me having the gene. In a previous post, I've listed all the factors that have me in an elevated risk category but LCIS is still not considered "cancer" when compiling the information for this gene test. Therefore, it was determined that I would have a less than 5% chance of having this mutated gene and it was suggested that I do not spend the money to take the test. I liked their honesty. Since it would have been another factor to help me to determine whether or not I should proceed with the preventative mastectomy, I was no worse off by not taking the test. I chose instead to go on a 5-day vacation to San Diego and Ojai, California.
What I did get out of this meeting, however, was the chance to pick a completely different oncologist's brain to get his opinion on what to do in my case. Once again, he seemed to embrace the idea of a preventative mastectomy (in my case) based on my risk factors, good health and attitude about the surgery.

The Top Three

So now what? I was told I had this "in-between" pre-cancerous marker called LCIS; I read about what it was, what it did and what it means through medical journals but, in all honesty, what do I need to do next? It kept coming back to three options:

1) Take Tamoxifin ( a chemo drug) for five years to lower the probability of getting invasive breast cancer.

2) Be vigilant and do an MRI once a year with a mammogram at the sixth month mark- every year.

3) Have a preventative bi-lateral mastectomy with reconstructive surgery.

Since my breast surgeon immediately suggested the Tamoxifin route, I made an appointment with an oncologist at the Joan Karnell Center at Penn Hospital to discuss putting poison into my body. Are you getting the feeling that I am ruling that one out even before I meet with him? I mean, I am a person that refuses to take aspirin for God's sake and now I am going to put a drug into my body where the side effects include blood clots, strokes and uterine cancer. Oh..and add in that it throws your body into menopause (lovely) for an onset of hot flashes, nausea and skin irritation among other fun symptoms. Of course, not everyone experiences those side effects but I will guarantee you that I would be one of the ones that do. Guarantee it!

I brought Bob with me since I read that you are supposed to bring someone to listen to what the doctor says in case your brain begins to wander or you freak out. I am pretty level headed so I knew I wouldn't start to cry or not listen but I wanted him to hear what I heard so he could be a sounding board later on. After explaining that Tamoxifin had been tested in 10-year studies and that it had significantly reduced the risk of breast cancer in patients, the doctor pointed out that the studies are unsure of what happens after the ten year mark. Does the risk go back up? I would only be 57 and, remember, my mom died at 56. He then looked straight at me and said, "Arlene, you would be a good candidate for prophylactic mastectomy. But first get the BRCA 1/2 gene test done to see if that helps in your decision process."

I also needed to add that while I was in the waiting area, I was next to the area where women (and men) were receiving their chemo treatments- some in wheelchairs, others not. I flashed back to my own mother and how sick she was during that period of her life. Yes, of course, this was in the 80's when she went through radiation and chemo and the drugs have been much improved over the years but I was so scared thinking about having to do that. I honestly think deep down that, if I had to, I could summon up the courage to go through all of that but it would take a lot to find it. I don't think I am strong enough. Wow..that was really hard to admit.

Which is why the second option- be vigilant, exercise and eat right- seemed more passive than aggressive. And I am not necessarily a passive, laid-back individual to say the least. Add in that if (or when) you found cancer, now you would be older and less healthy to endure chemo and/or radiation plus the possibility of THEN having to go through a mastectomy. Why not head it off at the pass while I am still healthy and young (er)? I am not one to take a wait and see attitude so it seemed that the mastectomy route was best for me. Where I kept wavering was the fact that my breasts would be removed and that I would not have any feeling in them- for ever. Plus..maybe, just maybe, I might never even get invasive breast cancer. Would I do all of this for no reason? What happens if I get hit by a Philadelphia crazy taxi driver and die after enduring the pain of a mastectomy or I get stomach cancer instead of breast cancer? What if.......?

At this point, I had already scratched off option 1. My strategy was to meet with a genetic counselor to take the BRCA 1 and 2 test and then meet with the plastic surgeon. My thought process was that the gene test would either add an additional risk to the already elevated risk factors while the plastic surgeon would inform me of what I would look like after the surgery. I also thought it would be great if I could speak to someone who went through a mastectomy so that I had a better idea of what it would entail. Now...where would I find that person or persons???

From the beginning...

Until recently, I had forgotten how much I loved to write. As a retail business owner for the past eighteen years, the only opportunity I had in terms of writing was filling out contracts and composing memos to my employees which weren't always written in a professional manner- especially during the last years of owning the business. You see, I was at wit's end in terms of stress and it was evident in my mannerisms, speech and even through my facial expressions. I felt that I no longer owned the company and, instead, it ruled me and controlled my life. Luckily for me, my husband was quite perceptive and agreed to put the business up for sale through a broker. Luckily for us, we sold it in 2006 before all hell broke loose with the economy. So now, here I am for the past year and a half...in Philadelphia...(of all places) after leaving idyllic Half Moon Bay, California to return to school and complete a one-year accelerated masters program in Sustainable Design.

And this is how I discovered that I loved to write. Going back to school after twenty-four years was certainly a challenge but having to write papers and then, add in, the seemingly unending 97 page thesis forced me to rediscover what I used to love to do...which was to write. Therefore I decided that, even if I was the only person to ever read this blog, writing would be the vehicle to get me through this ordeal. Who knows? Maybe by writing my story, someone else may gain insight while trying to make a hard decision.

Five days ago, I turned 47. I know, huh? Ugh! However, there was nothing I could do about it or I would have...trust me. I also found out a few months back through a biopsy that LCIS was discovered in my right breast. Lobular Carcinoma In-Situ. "What the heck is that?" I thought to myself. The word "carcinoma" certainly cannot be a good sign since we all know what that means...... C-A-N-C-E-R. The phone call from my breast surgeon, Dr. Sataloff, was pretty routine in that there was no cause for alarm and she just wanted to talk to me about options going forward.

When we met at her office near Pennsylvania Hospital, Dr. Sataloff strongly urged me to see an oncologist to consider taking tamoxifin as a preventative measure since my risk factor of having breast cancer had increased by 25%. Normally, a 25% risk factor is of slight concern but adding to that the fact that my mother was diagnosed with breast cancer at 49 and died at 56 and the fact that I chose to not have children, that I had my period before I was 12 and that both my sister and I had dense and cystic breasts, the risk factor was now elevated to a 65-70% chance of getting invasive breast cancer. Wow! Now what?

I immediately switched into "research" mode so that I could be prepared before I met with the oncologist. Since I had just completed my thesis, I was able to access the university library online and thumb through the medical journals to learn more about LCIS. Interestingly enough, I found that it was an "in-between" cancer in that some considered it pre-cancer while most considered it a "marker" for getting breast cancer at a later date. Hmmmmm. As a very black and white person, this made the decision process more complicated in that I now had to weigh all the alternatives carefully because, technically, I was in purgatory somewhere between heaven and hell.