The Surgery

Friday, May 11th, and surgery day is upon me. I have to be at the hospital at 7 am to start surgery prep. I scheduled my Lyft ride to pick me up at 6 am. I know what traffic looks like to Seattle on Friday mornings, and I didn’t want to take any chances of being late.

I get checked in and use the bathroom. A parade of nurses and specialty people start coming through. First is the surgical nurse. She gets me a gown and a bag for my clothes, purse and phone.

Next is the phlebotomist who is there to access my port. His name is Nestor. He’s an interesting guy. He says his son has decided to go into nursing as well. He wanted to be an architect and his sister convinced him, when he came here from the Philippines, to give healthcare a shot. He’s loved it ever since. It’s the ones who have stories to tell and are comfortable with people that make the best nurses. He’s one of those people.

I’m getting texts full of well wishes from friends across the country. I’m surprised that so many of them knew to text me before surgery, and it makes me smile. I’m even getting texts from people I’ve never met letting me know they’re praying for a successful surgery. I feel blessed.

The anesthesiologist and anesthetist nurse come in next. We talked about how I stayed really foggy and was nauseated after waking up from my port surgery. I explain that I’ve had a lot of surgeries and have never felt that bad after waking up. They decide to use more IV and less gas.

There’s a lot of waiting in between steps. The nurse comes in to apologize for the surgeon. I already knew that she didn’t operate until at least 8:30 am so I’m not too worried. The surgeon and resident are finally here. We chit chat a bit and then she gets out her Sharpie. She has a compass and draws lines across my chest. The lines are all very geometric. I think I look like Da Vinci’s “Circle of Life.” She takes some photos and tells me we’ll be ready soon. After I’m alone again, I take a selfie so I’ll remember what I looked like before. In hindsight, I should have had her take it for me.

After wheeling me into the operating room, I note that it’s not as cold as those before I’ve had knee surgeries. She says they don’t need it as cold for this type of surgery. I am moved over to the operating table. There’s all kinds of stuff going on now. I’m being hooked up to the IV, they’re putting compression massagers on my legs to prevent clots and deep vein thrombosis, they’re positioning me on the table and I’m talking with the anesthetist nurse about traveling and partying in Ibiza through my oxygen mask. He says he doesn’t want to be *that* 50 year old guy partying with the kids. I ask why not. And then I’m out.

I vaguely remember the recovery room. I remember being told I was in recovery. I remember being told that when I heard a beeping noise that meant I needed to be breathing deeper. I’m so tired and still so asleep.

Lake Union - From my Hospital BedA while later, I’m wheeled into my room. According to the reports, this would have been around 2 pm. I remember being told I was in my room and I remember saying I just want to sleep, and the nurses tell me that’s okay. About an hour later, they come back in to check on me. I’m a little more lucid, but still pretty groggy. Lucid enough to look at the clock and see that it’s about 3 pm, though. The nurses and residents come in separately to check my incisions. When they open the surgical bra, I’ve got some weird nerve thing going on because my breastbone is burning and feels tingly. There are pieces of gauze over the incisions to protect the bra and my clothes. Everything apparently looks good and after emptying the drain, I go back to sleep.

When I wake up again, it’s about 5:30 pm. I’m not hungry. I’m still tired. I look out the window and am impressed by the view. The nurses take my vitals and empty the drain, and I text family and a couple of friends that I’m sort of awake and that surgery went well. I look out the window and am delighted at the view. I can see my old office from here. I’m still tired enough that I don’t stay awake very long.

Downtown Seattle - Looking North to Lake UnionNext time I wake up it’s 7:30 pm. This time I’m awake. I’m starting to get hungry. The view out the window is beautiful. The sun is just starting to set over Lake Union. I ordered some food and have gotten up a couple of times. I still have the compression massagers on my legs and they say I have to have them on all night. They’re a bit of a hassle to get off and I’m a little afraid I’ll forget they’re there and try to get up myself. After dinner, I am out of bed for a walk down the hall. We walk slowly to the end of the hall where there’s a floor to ceiling window looking toward the lake. This is much better than trying to take the picture from my room! When I get back, she teaches me how to strip and empty the drain myself. I’ll have to do this for the next 7-10 days.

By 10:30 I’m getting tired again and let the nurses know I am ready to sleep again. They bring me some toothpaste and take vitals. I start what is a not at all restful night. I am woken up for meds at midnight, right after I’d just gotten to sleep. I woke up again at 3:30 needing to use the bathroom. She decides to do vitals while I’m awake, and I let her know we’re off schedule for the ibuprofen. She says she’ll be right back. After 40 minutes, I turn the light off and go back to sleep. She comes in 30 minutes later with the ibuprofen and insists I have crackers with it because it is hard on the stomach. So I eat crackers in bed at 4:00 in the morning. She says she’ll let me sleep til 4:30. When I wake up again it’s 6:30 am and the surgeon is here to see me.

The surgeon asks what I think, and I tell her it looks good. I’m swollen and my chest looks very different than it did the last time I saw her. She checks the incisions and tells me that it went well. She says she’ll call me with the pathology results as soon as they come in, and she’ll see me in a week to 10 days to remove the drain.

The nurse comes in shortly after and shoves a menu into my hands saying something about needing to order breakfast soon. I am barely awake and am not hungry yet. I have no idea what I want other than to go home where I can sleep.

The residents come back to check my incisions. One of them suggests that instead of gauze I could use a sanitary pad over my incisions to help keep the fluid from staining my clothes. We talk a little about the specialties they want to go into. One of them wants to be a cardiac surgeon and the other a radiologist.

I am finally hungry enough to order breakfast. Another nurse comes in and I ask about getting a shower. They decide that I have to wait for 24 hours for a shower so that the glue on my incisions can dry. She comes back with a warmed package of bath wipes and helps me get cleaned up and dressed. I let my friend know that I will be ready to go soon and will let her know when to leave to get me. I completely forget that there was a ton of I-5 construction this weekend.

The last person I need to see before I leave is the in-patient physical therapist. She and I walk the hallway talking about what lymphedema looks and feels like and what I can and can’t do with my arms to prevent it. I can do some exercises on a pillow, I need to sleep with a pillow under my arms, and I can do hanging arm circles.

I’m now ready to go. They’ve called for patient transport (aka a wheelchair). I’m still getting my things together when the guy arrives with the chair. He’s earlier than we expected. He wheels me down to the door and waits with me until my friend arrives to take me home.

Thankfully, my friend and I stopped to pick up a bite to eat on the way home or I’d be kind of screwed because I can’t open the refrigerator door and I can’t reach the microwave.  I’m relieved to be home. Now the healing can begin.

Posted in Surgery, Treatment | Tagged , , , , , , , , , , ,

Pre-Op Surgical Appointment

At the pre-op appointment on April 26th, I met the resident who would be scrubbing in for my surgery. She was nice. I liked her. We talked generally about the procedure and if there are any concerns I have.

Any concerns…  Well, yeah. I have a list. I have a tumor that started out the size of a plum in my chest. My first and primary concern is that the cancer is removed and she gets it all the first time. My post-surgery limitations are next on my list. I ask for someone to stretch my shoulder out while I’m under. I’m worried about lymphedema. I’ve heard and read quite a bit now about side effects of radiation, and I’m concerned that between the surgery and radiation the range of motion in that shoulder will be more limited than it already is. Not that it’s horrible. It’s just not what it was before, and it’s gotten a little worse over the years. I have other nightmares about radiation but I need to save those for the radiation oncologist. I let them know that I had problems with the anesthesia when I had the port put in, and that I also don’t want opioid pain killers after surgery.

I will be having a partial mastectomy, lymph node dissection with a bilateral breast lift. It all sounds a lot more glamorous on paper than it does in real life. This isn’t a boob job. Really, it’s not. This is removing a tumor the size of a plum from my right breast and making both sides more or less match in size. Even if I had wanted implants, I’m not a candidate because of the radiation.

When the surgeon comes in, we talk about the chemo and some of the side effects that are causing issues for me. She makes the right kinds of faces. I feel vaguely comforted. We talk through the surgery. She draws some pictures of what the incisions will look like, and that with this plan, she will be able to get to the lymph nodes in my armpit without having to make a separate incision. I’m glad I don’t need a separate incision. I have the feeling that healing in this area is already going to be hard enough without having to worry about what else got cut along the way. At the end of our appointment, she writes a an order for physical therapy with lymphedema prevention, and we all agree that I will alternate Tylenol and ibuprofen every 3 hours to manage any pain that I have after surgery.

I am shepherded to the scheduler’s office where I sign the consent paperwork and get the pre-op instructions. We talk to the anesthesia coordinator and work through the list of medications I’m current prescribed and taking, and they say they will figure out what made me feel so out off it for so long after my last surgery.

People keep asking me how I feel about my upcoming surgery. I don’t know how to answer. I am eager to have it done. I wanted it done 5 months ago. I’m more worried about how the radiation will affect me. My first surgery was in my mid-20s when I ripped my ACL in a ski accident. Orthopedic surgeries have been sort of a staple of life since then. While I think 4-6 weeks sounds like a long recovery time, the only other thing that concerns me is that they get all the cancer the first time. I’ve been told that sometimes, after the pathology report comes back, they have to go back in because they didn’t get enough margin. I am planning to be at my niece’s graduation on June 1st, so a worst case scenario would be having to go back in for more surgery.

When I get home, I’m actually a little relieved to have this part done. My leave from work is scheduled and approved. I have support planned for after surgery. I have a friend who’s an RN who will be flying in from MN to help me the 1st week. We are talking about having her daughter fly out at the end of the month to help me get back and forth to my niece’s graduation. I’ll be 4 weeks post-op at that point. I will be able to manage on my own, but won’t be able to lift my bag and certainly not put it in an airline overhead.

The next morning, while I’m in for my first Herceptin by itself, I see an email telling me that I have a message waiting in the patient portal. When the oncologist comes in, she’s looking through the chart and tells me I have a message from the surgeon about the surgery date. Not 5 minutes later, the surgery scheduler is calling me to tell me the same. I tell her that I will stop by after my Herceptin infusion is done. I think she’s freaking out more than I am.

I’m stunned. I’m disappointed. I’m tired of surprises.

When I get done with my infusion, I walk over to the building where the surgeon’s office is and let them know at reception that I’m there to talk to the scheduler. By the time I get there, the rescheduling is already done. When I ask the scheduler why, she hands me the phone to talk to the surgeon. In her email message, she’d said that May 1st wasn’t viable because my body needs to have at least 3 weeks to start recovering from chemo before I can have surgery. She says that May 11th is the first day she could do the surgery. When I get there, I learn she will be at a conference the following week. Over the phone I suggested that we wait until June 3rd, and she says that’s not possible, either. There is a specific window after chemo where surgery can be done. One to make sure that I have a safe recovery, and the other is so that the cancer doesn’t get a chance to start growing again. Great.

My life is on hold yet again.

My first call is to my sister. I can’t make the graduation on June 1st. My next call is to my friend who will be flying in to help me. We have to move her flight. She has to re-request her time off. I’m a little scared that she won’t be able to take leave 10 days later.

I start the process of notifying my managers and contacting the insurance company regarding my leave dates.

I hate cancer.

Posted in Surgery, Treatment | Tagged , , , , , , , , , , ,

Pre-Op Scan Results

Mammogram/Ultrasound

I had a post-chemo/pre-op mammogram and ultrasound. This is mostly to ensure there is no new cancer (not likely since my oncologist and I could both feel the tumors shrinking), and to measure the mass that’s left so that the surgeon knows what to look for where.

It occurred to me to go back and look at the posts I had made when I first had these tests done. I was surprised and a little disheartened to see that I’d never documented the results of the scans before. So now, the sizes of the tumor and lymph nodes are included below because I’m talking about a decrease in size of each.

The results of the mammogram back in October were that I had a 46 x 37 x 39 mm lobulated high density mass with spiculated margins and occasional coarse calcifications. What does all that mean? When cancer grows, it’s not a nice, smooth piece of tissue like the rest of the cells in our bodies. Women’s breasts normally develop extra spots of calcium deposits as we age. They aren’t necessarily an indicator for cancer, nor do they increase your risk for getting breast cancer. What makes these calcifications different is their size, shape, and how they show up in the breast. In my case, they were large irregular, rod or V shaped, calcifications that followed the path of the milk duct. Well, that and it was already almost 2 inches across and about 1-1/2 inches around. Interestingly enough, each scan type comes up with a different measurement for the tumor. They differ only by a couple of mm, but still interesting how each “sees” the tumor.

The mammogram part of this was a little stressful. When I thought I was done and going to be called back for the ultrasound, the mammogram technician came back out and wanted me to come back in for another scan. They found some new calcifications, and we needed to prove that they weren’t cancerous. Talk about freaking someone out. All the things you’d expect went through my mind while I was back out in the waiting room a 2nd time. Was the chemo a waste of time? How can I have new cancer? What do I want to do about it? After the 3rd scan, the radiologist came in and confirmed that what they were seeing were what are called skin calcifications, which are benign and nothing to worry about. My breast tumor now measures 42 x 22 x 22 mm, which is about a 10 mm or just less than a 1/2″ decrease in size, which is about a key lime rather than a large plum.

The Ultrasound originally showed my breast mass at 39 x 21 x 31 mm, and three affected lymph nodes, the largest with a 29 mm diameter, which is roughly the size of a walnut. A normal lymph node in the arm pit is usually about smaller than 1/4″ around. My largest lymph node also shrunk and is measuring 13 x 24 x 13 mm. It’s more oval in shape, so at its length is about an inch and it’s got a circumference of about 1/2″.  So it’s about the size and shape of a grape.

MRI

The original MRI, done in November, showed the breast mass to be approximately 43 x 52 x 32 mm, so a little bigger than the mammogram. There was no extension to the chest wall, skin, or nipple areolar complex, which means that it’s not spread further than the milk duct. There was also no evidence of multifocal or multicentric disease, which means that it’s a single tumor, not multiple ones bunched together.

The new MRI shows an irregular mass with spiculated margins and rim enhancement has decreased in size. It now measures approximately 36 x 21 x 15 mm in diameter, as compared to 52 x 43 x 32 mm on the prior exam. Axillary lymph nodes: The previously biopsied lymph node with a marker clip has dramatically decreased in size, now measuring approximately 6 mm in maximum diameter. However, at least one residual abnormal axillary node is evident. It measures 4 mm in maximum diameter. The deeper nodes, evident on the CT of 11/8/2018 and the CT PET of 11/14/2017 are not included on this exam. This means that the deeper nodes are no longer enlarged or showing signs of cancer.

CT Scan

The November CT scan showed Lobular enhancing mass (breast tumor): 38 x 33 mm in with a 10 mm subpectoral lymph node and largest axillary node measuring 22 mm. See what I mean about different sizes? The CT sees the breast tumor about the same as the ultrasound, but sees the lymph node more like the MRI.

My latest CT finds decreases in the sizes of the tumor and lymph nodes as well, along with no new or advancing metastasis or adenopathy. There was a decrease in size of the right breast mass 26 x 16 mm, which was previously 37 x 28 mm.There is one lymph node that has not “resolved,” and it measures 15 x 15 mm when it was previously 17 x 13 mm.

In other words, for all 3 of these scans, chemotherapy did what it was supposed to do, which was to kill the cancer and shrink the tumors.

Posted in Surgery, Treatment, Uncategorized | Tagged , , , , , , , , , , , , , , , , ,

Unfulfilled Dreams

Thinking back to my earliest memories, I was fascinated by and loved science. I. Loved. Science.

When I was little, maybe 4 or 5, we lived in a duplex in St. Paul. One day, the kid who lived upstairs decided to play with matches and started a fire that caused a lot of damage to the upstairs unit. The landlord was doing the repair work himself, with the help of his family and my dad. One day he was there working on the house, and I was playing on the sidewalk in front of the house. He was, I think, going next door for something when he just fell over dead into the hedge. I remember going to get the neighbor. I remember the fire department and medics coming to the house and working on him. I remember hearing later that he’d died.

What I don’t remember is being afraid or scared in any way. One of the things I think that stuck with me were those medics. Later, when I was about 8, I started watching Emergency! after school. At first, I wanted to be a paramedic. Later, I decided I wanted to be a doctor. My aunt gave me the book, The Making of a Surgeon, by William Nolen, MD, a doctor from Minnesota. I devoured it. He wrote 3 other books, and I devoured them, too. I went all through high school and into college wanting to be a surgeon. I took every science course I could get my hands on and did well in all of them. Anatomy and physiology were always easy As for me.

As most of you know, I’m not a surgeon today. I don’t even work in the medical field. What happened? Life. Just like everyone else. Thinking about it now, I don’t know why I didn’t pick a lesser path than being a physician while staying in the medical field. Or why I didn’t talk to someone about why I was having such a hard time with organic chemistry and algebra/calculus. I guess I thought that if I couldn’t understand them in high school, I’d never get them, so I had to walk away. A little arrogant in hindsight, but I also knew that some people were better at certain things than others, and I really was better at other things.

I desperately wanted to take college physics but was struggling so much with math that I felt I had to abandon that, too. Then again, there were only so many hours in a day, and so many credits you could take at a given time., and picking science back up just wouldn’t fit with all the rest of my classes and my jobs, etc.

So why did I keep repeating to my oncologist and surgeon that I had wanted to be a surgeon and was pre-med in school? Because I desperately wanted to be treated as an equal. When I walk this back, I remember when I was living in Houston, I had the same primary care doc for 10-12 years. When I had some concerns and needed a specialist, he’d give me a name. Usually, this would be someone in the insurance network, and someone I’d never heard of before. Then, he’d look at me and ask me if I wanted to know where he’d send his wife. I felt like this was how he’d treat a peer who asked for a referral. I wanted that with my oncologists and surgeon, and I subliminally knew that I needed to do something to create the kind of bond I had with my primary care doctor because I didn’t have the luxury of time to grow relationships with any of them. All of this grew out of the anxiety of being diagnosed with cancer.

I realized, just before my surgery, that this whole story about wanting to go to med school and then not even working in the medical field wasn’t doing me any favors. In fact, I realized it made me sound like an idiot. This wasn’t helped by actually being an idiot when it came to cell biology, organic chem and a few other things that I’ve tried reading up on lately and finding that I understand literally a dozen words in the article. That’s humbling.

So… I decided to own it. In my pre-surgery appointment, I finally told the surgeon and the resident who’d be scrubbing in on my surgery that I have found recently that I know nothing about anything having to do with biology anymore. That frankly, I’m an idiot anymore. She laughed and tried to tell me it was okay.

 

Posted in The Not Cancer Part, Treatment | Tagged , , , , , , , , , , , , ,

Partial Mastectomy Scheduled

The surgery, a partial mastectomy, or lumpectomy, with axillary node dissection and bilateral breast lift, is scheduled for Friday, May 11, 2018. I’m a little nervous. I’ve met with the surgeon and her resident regarding the surgery. She talked through her plan with me again. I was pretty emphatic with both the surgeon and the resident regarding the outcome I was looking for in addition to not having any residual cancer left when she was finished.

Getting this surgery scheduled was taxing, but it’s done and we’re moving up quickly on surgery day. I’m having this done on a Friday morning. She doesn’t normally operate on Fridays but because (a) I’d wanted to travel for my niece’s graduation on the 1st of June, (b) she’s going to be out at a conference the following week, and (c) this is the post-chemo window we have to work within, we’re doing it on Friday morning.

My after care is arranged. I am being picked up at the hospital by a friend on Saturday, and my friend from high school, who also happens to be an RN, will be picked up at the airport by my neighbor later that afternoon. I am opting to manage the pain with only Tylenol and ibuprofen so I won’t be too out of it the day after. At least I hope not.

My To Do List

The week before surgery is usually a little crazy and frenzied for me. I have a lot of things to get done so that I can manage without doing anything for one to three weeks post-op. Having had 5 knee surgeries and a shoulder repair, I have a pretty decent idea what to expect.

  • Wrap up loose ends at work
  • Miscellaneous Appointments
    • PT appt
    • Chiropractor appt
    • Dental appt
    • Massage appt
  • Fill prescriptions
  • Laundry
  • Make sure clothes are where you can reach them
  • Change the bed
  • Guest Room & Bathroom
  • Trash
  • General Cleanup
  • Groceries
  • Hospital Bag – phone charger, ID, insurance card, keys
  • Make sure my rides are arranged
  • Breathe

Things I Forgot

  • Pajamas with buttons
  • Gauze Pads
  • Extra Tylenol/ibuprofen for my purse
  •  A piece of ribbon for the drain
Posted in Milestones, Surgery, Treatment | Tagged , , , , , , , , , ,

More Appointments Than Carter’s Got Pills

Since the surgery calendar was moved by 10 days, I’ve had a ton of conversations with different departments in the hospital about scheduling appointments.

Back in the mid-90s I was working as a meter reader for the water department back in Minnesota. I slipped down some icy stairs and had grabbed the railing on my way down, which tore the labrum in my shoulder. It is sort of like tearing the meniscus in the knee. Orthopedists call it a SLAP tear. (The linked article is really good at describing what it is and how to fix it without being gross). I had surgery to fix this almost exactly 10 years ago. I never fully recovered my range of motion (ROM) or strength in that shoulder. Some of that was due to not getting enough physical therapy (PT) through my insurance, and the rest was disagreement on what PT I should be getting between my orthopedic surgeon, my chiropractor and the physical therapist. Funny thing is that the PTs think I’m close enough.

After reading about post-surgical and post-radiation for the partial mastectomy I’m about to have, I asked the surgeon to help break up the scar tissue and adhesions that have formed in that shoulder because I’ve been a slug and not done much about keeping it moving the way I should have. Yes, I have a ton of shoulda done this or thats about my health. What I also have is a “Today’s the Day it Changes,” and it’s time to start taking better care of myself, with exercise and strength training going back on my Must Do Regardless list. Getting my shoulder back is one of those things.

So… the surgeon wrote an order for pre-op PT to help loosen up my shoulder. Part of this is because I want to get it looser before I start doing anything again so I don’t hurt myself. Because she included lymphedema prevention as part of the prescription, it’s difficult to get an appointment. And by difficult, I mean near impossible. It’s taken an entire week to get an appointment with one of the two therapists that have training with lymphedema. When I finally do get in to see her next week, we’re going to decide what to do about my shoulder. I may still end up having an orthopedic surgeon manipulate it while I’m unconscious on the table. According to her, even 2 weeks wouldn’t be enough to do what she thinks is needed to get more ROM out of it. We’ll see.

My oncologist has also been working with me to help find workarounds and treatments for chemo brain. There are multiple pieces to this. First, there is a neuropsychologist that does a day-long assessment of where you are. I personally think that for people who are interested they need to do a baseline before giving any chemotherapy drugs so you know where you started. That would mean telling you that chemo brain is a possibility, though. I haven’t seen that happening. When over 78% of patients reporting cognitive issues, a.k.a. chemobrain, during and after chemotherapy, they really need to add this condition to the list of side effects so people know what they’re getting into. Anyway… the neurophych unit at the hospital is understaffed at the moment, so the soonest I can get in is October August (date subject to change). The neurophychologist doesn’t want to talk to me until I’m 3 months post-chemo anyway, which would be July, best case. In between, I’m meeting with Occupational Therapists and Speech Therapists, who are starting assessments and giving me workarounds for some of the more glaring issues. Like getting distracted enough while making an egg to leave a pan on the stove burning butter or dropping the toast a 2nd time and having it nearly be on fire by the time I remember it’s still in the toaster. Not cool. I also got some suggestions for managing the things that I can’t remember to do even though I keep telling myself I need to get them done.

I’ve also got the dental appointments to do the fluoride varnish, massages, chiropractic appointments and meetings for things I need to wrap up at work before I go on leave.

Needless to say, to get me in to all these folks pre-surgery means spending a lot of time on the phone trying to get time scheduled and understanding what it is I need today. It can be exhausting. Calgon take me away!

Posted in Surgery, The Not Cancer Part, Therapies, Treatment | Tagged , , , , , , , , , , , , , , , ,

Surgery Planning

The surgery aspect of breast cancer treatment is more complicated than you’d think. There are lots of different options for surgery. Some choices are better than others for recovery and quality of life later. Unfortunately, these are not all choices we, as cancer patients, get to make. The cancer makes some of these decisions for us ahead of time and our surgeons make most of the rest. The patient really only has the illusion of choice when it comes to surgical options. Then, there’s how much time off from work you need to heal, and whether or not that’s something you can afford to do.

When I first met with the surgeon, she asked if I had thoughts about what I wanted to do about the tumor in my breast. I told her that I wanted a double mastectomy. I didn’t want a breast cell left where cancer could grow back. Turns out there isn’t really a way to do that. There would still be breast cells within the skin tissue, so it’s not possible to get them all. But I don’t want to do this again.

A double mastectomy is a really big surgery. The recovery for that surgery is long and difficult. 12 weeks with a minimum of 5 days in ICU after the surgery while the recovery time for a partial mastectomy (lumpectomy) is 4-6 weeks with one overnight in the hospital. The kicker is that having a double mastectomy would only decrease my chances of recurrence by 2%. The math there seems simple. It’s a lot of extra pain, discomfort and time off work for only 2%.

Another thing not in my control is when I have the surgery. No one told me there was a very specific window for doing the surgery until the week before it was originally planned. So… I not only have to be done with chemo, my body has to have a chance to recover from chemo – all those issues with blood counts and skin infections came back to mind – and also be before the tumor has a chance to start growing again. Oh, and there’s no checkpoint in there to see if you’ve got a life alongside any of this. Cancer is more important than your quality of life.

Doing the Math and Counting Your Pennies

I have the fortune of being offered Short Term Disability (STD) leave for 90 days (6 weeks) per calendar year. While on this leave, I receive 80% of my current salary. After 90 days, it is Long Term Disability (LTD) leave, which is paid at 60% of current salary. For most people, myself included, a 40% reduction in salary is a pretty big dent. Honestly, a 20% decrease in salary’s a pretty sizable dent, too. Luckily, I also have the ability to work from home, which means that I can go back to work sooner. A lot of other people don’t have this luxury. I’m wondering what this would have been like if I’d still been a meter reader or worked somewhere doing physical things every day. I think I’d be screwed.

Seeing as I’m a single person living alone, I also have to carefully weigh how long I can afford to be away from work before it gets to be a significant financial burden to me. The answer is, not long. Part of that equation is also that I don’t have family living nearby, so I would need to either fly people in to help, and/or hire a nurse to come to my house and help with dressings and meals and whatnot. Plus I’d need to have someone come in to clean my house and help with laundry for at least 3-4 months post surgery. Yeah, that would all get really expensive really quickly.

Things to Know Ahead of Time

The oncologist and surgeon aren’t likely talking much before you’re done with chemo.

The new scans to determine whether or not the chemo is working will be done around 1 week before chemo is done. They won’t do them more than 2 weeks before chemo is finished.

There is a specific window for surgery after chemo is done. For me, it was 3-4 weeks post chemo. Why? First because the body needs time to recover its immunity and ability to clot after stopping chemo. Meaning that the white blood cell and platelet counts go back up. Secondly, for most of us, there is still live cancer in our bodies that they don’t want to start growing again after stopping chemo.

Bottom line – if you have something going on in your life around the time that you’re moving from chemo to surgery and on to radiation, about midway through the chemo is the time to start speaking up. If you’re lucky, the stars will align and you’ll still be able to do life things in between these stages. If not, well… there’s next year.

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