Jacki's Journal
5 entries, last entry on March 25, 2008
Finishing touch
March 25, 2008
I never thought I’d elect to have surgery after going under the knife for the removal of a cancerous tumor that somehow lodged itself in the tissue of my left breast. Surgery is bad enough when it’s medically necessary. It seems silly then to choose to submit to general anesthesia and all that follows, like the slicing and sewing of skin and muscle, the pain, the recovery, and the potential for complications. Yet I’m considering it. I’m more than considering it, actually. I have a surgery date—April 23—and one week from today, I am scheduled for a pre-op appointment that will seal the deal. I have seven days then to determine whether I’ll keep or cancel this appointment. I’m leaning toward keeping it. Here’s why.
Seven years ago, I had a baby boy. He weighed 10 pounds, nine ounces. Almost five years ago, I had another baby boy. He weighed 10 pounds, two ounces. I gained 50 pounds and then 42 pounds with these monster guys and all these years later, I’m left with loose, sagging stomach skin and a separated muscle underneath. I’ve tried all I can to get rid of these battle scars. During the past year, I really kicked my efforts into high gear. Motivated by the urge to prevent a cancer recurrence, I overhauled my diet—no soda, no sweets, no red meat and low fats, calories, and sugars—and began exercising more vigorously than ever. My results have been grand. My heart is strong, my energy is high, and my weight is down by 15 pounds. Still, my tummy skin remains. It’s worse really. The less fat I have, the more the skin hangs. I want it to go away.
No amount of diet or exercise will fix my problem. But a tummy tuck will. So that’s what I’m pursuing. Some think I’m crazy, selfish even—a few years ago, while in the throes of cancer treatment, I would have too—and some think I deserve it. Here’s what I think: I want to feel comfortable in my skin and in my clothes. Right now, I don’t.
If all goes according to plan, a surgeon—a guy who happens to specialize in breast cancer reconstruction using tummy-tuck skin—will remove a football-shaped chuck of skin from my abdomen. He will repair and reshape my muscle, reposition my belly button, fix an umbilical hernia—yep, I’ve got one of those too—and then sew me back up. This outpatient surgery will cost me a few hours in recovery, 10-12 days of difficulty at home, six weeks of healing, and a few thousand dollars—no insurance help for this cosmetic procedure. The more I think about it—the good, the bad, the unknown—the more I want this tummy tuck. Even after breast cancer. Maybe because of breast cancer. I want to feel the best I can possibly feel, you see—on the inside and out. I’ve done all I can do on my own. I consider this my finishing touch.
Conversations (3)
Preparing for chemotherapy, January 2005
March 22, 2008
Four years ago today, I was in Halifax Hospital in Daytona Beach, Florida. At 12:48 PM, I gave birth to Joey. It was quite a day. Joey weighed 10 pounds, 9 ounces and was the biggest newborn baby I'd ever seen. Today, exactly four years after he was born, I was in the hospital again—this time at Shands in Gainesville, Florida. It was also quite a day.
Today I learned that I will begin chemotherapy in about one week. I have been prepared for this step in my breast cancer recovery but I was still secretly hoping a doctor would come along and tell me that I don't actually need this treatment. But I do. And soon it will begin.
First I need to get a chest X-ray. This will indicate whether or not there is any spread of cancer to my chest. Chances are good that nothing has spread but it will be done anyway. Then I need to have tests done on my heart for a baseline reading. One of my chemotherapy drugs can damage the heart muscle so this will allow for comparison as I undergo treatment. Then I will get a port, or central line, surgically inserted into my chest. This is how the drugs will enter my body each time I go for treatment.
My treatment will include three drugs—Adriamycin, Cytoxan, and Taxotere. I will go for "infusion" four times, every two weeks for eight weeks. Initially, I was told I would go every three weeks but this is a new protocol which speeds up the process (the other would take 12 weeks) and will allow me to get radiation sooner, once the chemo ends. But it's more aggressive (with just two weeks to recover between treatments) so if I cannot tolerate it, I will switch to every three weeks. Each treatment will take about four hours (each drug takes a certain amount of time to enter the body) and I can read, eat, listen to music, or watch TV during the process. I will sit in a room with other patients who are also receiving chemo.
Prior to the start of chemo, I will meet with an oncology nurse who will prepare for what to expect with chemo. Side effects vary with each person. I may be tired and will be prone to infection. Nausea and vomiting can occur but there are drugs to prevent these side effects. The only pretty certain side effect is that I will lose my hair. People have recommended that I shave my head once I notice my hair falling out—it can be traumatic to watch it fall out in clumps—so I think I may have Joey shave it for me. He always wants to help me cut his daddy's hair and I never let him. I really don't want to lose my hair and I think Joey can help me bounce back from this experience. He has a very simple approach to life right now. When I was wimpering and whining about pulling off my bandages after surgery, he said, "Pull it off—you're not going to die, mommy!"
Speaking of death, I do not think I will die from this cancer. Besides statistics which are on my side (I have an 85% chance of survival), I really believe I will be fine in the end. I feel positive and confident and really only worry about how the treatments will affect me. I'm not good at giving up my routine. I want my family to function like it always has, and I may have to give a little. That makes me anxious. But I plan to take one day at a time.I also plan to keep reading and talking to others who can share cancer experiences. I plan to look into complementary therapies (such as diet, exercise, natural remedies, relaxation) and I plan to keep writing.Mostly, I plan to enjoy my new four-year-old and his little brother—and my family and friends and all that is good in my life!
Clarification
March 20, 2008
My doctor says those disturbing words used in my echocardiogram report to describe the valves of my heart— dilated, thickened, insufficient—are “normal variants.” They are medically insignificant, just as I’d imagined they must be. I’m thankful for the clarification, though. And my doctor is glad I poked around for more information.
“I would have been disappointed if you didn’t ask about them,” he said.
I would have been too.
Context matters
March 20, 2008
Quick. Get me a cardiologist. My right ventricle is mildly dilated. My aortic valve is mildly thickened. And my tricuspid valve is mildly insufficient.
I’m sure this is all somehow medically insignificant. Otherwise my oncologist would not be telling me I’m good to go should I opt for a tummy tuck surgery (more about this tummy business later). If my heart couldn’t take it, surely he’d be warning me. The guy did save me from breast cancer, after all. He clearly knows what he’s talking about.
This morning, my good doctor e-mailed me a copy of my latest echocardiogram—that’s how I was able to pour over the details of this July 2006 report. I’d asked him for it as I continue to search my soul for guidance regarding my tummy, and he swiftly sent it my way. I wanted to know how strong my ticker is—both my year-long therapy with the breast cancer drug Herceptin and my four doses of the chemotherapy drug Adriamycin put me at risk for compromised heart function and so my heart was monitored for a bit. I wanted to know today, based on my last screening, how I’d fare under general anesthesia and how my heart would tolerate a two-hour surgery—should I go through with it.
I’m good to go, says my doc. Still, I’ve asked him for a bit of clarification. What does this troublesome wording—dilated, thickened, insufficient—mean, I want to know.
This is what I want you to know: Context matters.
More and more, we patients rely on information via the Internet or in this case of mine, e-mail. These methods of research are void of human contact and medical opinion and therefore lack context. Who knows, maybe a thickened aortic valve is a good thing. Maybe it’s not necessarily good but not bad either. I don’t know. Until someone clears things up for me, I will remain uncertain. That’s why I’m following up with my doctor. You should too.
Whenever you are concerned about your health, do your research, ask around, dig up all you can. Then talk to a medical professional who can iron out all the kinks in what you’ve gathered. Balance is always a good bet. Really, it is.
The way it all began, December 2004
March 19, 2008
What you are about to read happened long ago—more than three years ago to be exact—and the fact that I first wrote the following words that long ago is such good news. It means I’ve survived breast cancer for about 1,095 days now. Nothing makes me happier.
This snippet was the very first passage I wrote about me and my cancer. I will continue to publish my posts from the past. I will share some real-time entries too so you’ll know how I’m faring all these years later. Keep coming back, won’t you?
My breasts have been a problem for a long time. For years, they were too big. I was a 34 DDD and hid them with tight fitting bras and under big shirts. So I had them reduced and lost 4 pounds of tissue. I am now a 34 C which is much more manageable. Surgery left me with scars, loss of sensitivity, and an inability to breastfeed my babies. This has not been a big deal to me, just life circumstances and I’ve adjusted to them. And now I’m on to another life circumstance with these problem breasts. I have breast cancer.
On November 16, 2004, I felt a lump in my left breast while taking a shower. I have always been aware of what my breasts feel like. I have a lot of dense tissue, so dense that the surgeon who performed my breast reduction had trouble separating the tissue to take some out and leave some in. My breasts always seem lumpy to me and I never knew if I’d be able to tell the difference between normal and abnormal tissue. Four years ago I had a mammogram because of something I felt. It all turned out fine. It was just the dense tissue. All of my annual GYN visits have revealed nothing abnormal. But I’ve always been aware and curious which is why I found something in the shower. I knew it was not normal. It was hard and felt like a small frozen green pea. It moved around and for the first few days, I had a hard time locating it. Once I became obsessed with it, I could find it immediately.
I went to my OB/GYN on November 18. My doctor felt the lump but was confident it was nothing to worry about. It moved around easily, there was no discharge from my nipple, I did not feel any pain: all signs that it was benign. But it’s routine to get a mammogram for any mass so I got one the next day.
I was the youngest person waiting to get my mammogram, another sign that this lump was nothing serious because it is not common for young women to have breast cancer. Mammograms are not even recommended for women under the age of 40. I am 34.
The mammogram films looked OK, and the technician told me the doctor would talk to me but that she was not worried about anything. This was true but she did an ultrasound anyway to look further at the lump. She determined it was not a cyst, which is fairly common, and nothing serious. It could be a fibroma (a common growth that can be removed or left in place without harm) or it could be cancer. She said she wanted me to have the lump removed. She wanted it out and in a jar, she said. I asked her if it could be cancer. She said it could be.
On November 23, I had a biopsy. A large needle was placed in my breast and a piece of the lump was pulled out. The surgeon had a hard time getting a piece, however, because it moved around so much. He said this good, the movement. He sent the tissue to pathology and told me to call his office the next afternoon for the results.
The next day, November 24 and the day before Thanksgiving, my phone rang at 10:00 AM. The doctor who did the biopsy said the pathology report was back already. He said that unfortunately, cancer cells were found. He said I would need a lumpectomy (surgery to remove the lump), radiation, and possibly chemotherapy. He told me to buy a book called Dr. Susan Love’s Breast Book. I got the book that day.
Somehow, I made it though the Thanksgiving weekend, with my thoughts jumping from the hope that this would turn out OK to the fear that I would not see my boys grow up. My mind wandered and worried about surgery and what treatments I would have. I wondered if I could have more kids and whether or not I would lose my hair. I cried and lost sleep and was hopeful too. I learned a lot from reading my new book. I learned that many women do go on to have kids after cancer but I also learned that chemotherapy in young women can cause early menopause. I learned that I have an 85% survival rate and also that I will get tiny little tattoos surrounding my breast to aid in the proper delivery of radiation. These permanent tattoos will also alert any future doctors that my breast has had radiation because I can never have it again in that same area. The book helped me feel positive about this journey but it also helped me face reality.
On November 29, I met with a surgeon at Shands who prepared me for my first step: Surgery. He said he would remove the lump and would determine whether or not my lymph nodes were cancerous. He would check all the margins around my breast to see if any surrounding tissue was affected and would identify all the defining factors of my cancer. If he found extensive cancer, he would have to remove my breast. I had to sign a form stating that my surgery was to be a lumpectomy but could turn into a mastectomy. My surgery was scheduled for Friday of this same week.
On Thursday, December 2, I had a radioactive dye injected into my breast. The dye slowly collected in my main lymph node, the sentinel node. During surgery, this lymph node would be blue so the doctor could easily find it and biopsy it. The biopsy would give him clues about my other lymph nodes. For the rest of this day, I was very anxious about surgery. I didn’t know what kind of prognosis I would wake up to hear and whether or not I would still have my breast.
I do have my breast. And I have a fairly good prognosis. My lump was removed and measured 1.1 cm, which is small. My lymph nodes were negative for cancer, although four were removed for biopsy purposes. My margins were clear, and there was no apparent spread of cancer. My cancer is considered stage 1. And that is good. I have two incisions, one in my armpit where lymph nodes were taken and one underneath it, on the side of my breast. They are both about 3.5 inches long. Besides a bad skin reaction to the tape I was bandaged with, everything went well. There are minor inconveniences right now. As my incisions heal and my skin tightens, it’s harder to lift my arm. So I have exercises I must do each day. Because of the missing lymph nodes, I may have trouble with swelling in my arm so I have to watch for that. I have not been able to shave my armpit since my surgery on December 3.
And now I await the next step in this battle. I will begin receiving chemotherapy in mid-January. This will last for three months. I will go for treatment four times, once every three weeks and will have a combination of drugs sent through my body via IV. The purpose of chemo is to kill rapidly growing cells, and cancer cells are rapidly growing. Unfortunately, all rapidly growing cells are killed, like hair cells and bone marrow cells. The chemo should kill any cancer cells that floated away from my breast, if any did. I don’t know how I will react to this process, as each person responds differently. At the very least, I hear I will be tired at times during each three-week time frame. I may also be tired from the radiation. This will begin three weeks after chemo ends.
I will receive radiation every day for 6 weeks. The purpose of radiation is to zap the actual area where the cancer was found to prevent it from recurring. Many women take a drug after chemo and radiation to prevent recurrences. The drug (usually tamoxifen) is taken for five years. My body will not respond to this type of drug due to negative estrogen receptors (if they are positive, the drug can be taken) so chemo and radiation will be my only two real treatments.
For now, I am trying to keep life simple. Joey and Danny help me do that. Joey knows I am frequently going to the doctor for a “boo-boo” I had in my “booby” and he has been very attentive. One day after a doctor appointment, he said, “Mommy, you need to go home and rest. I’ll bring you a banana.” He is almost four years old. Danny, at 19 months, does not seem to know anything is going on and it’s my hope that he never has any recollection of this path our lives are taking. I will never forget it, though, and that’s OK. I will take this experience and make it matter.
A friend sent me a breast cancer bracelet inscribed with trust your journey. I do. I trust that I will be fine in the end. And I trust that I was given this fight so I can help others. That is why I have written this. I hope everyone who reads about my journey is affected in some way. Perhaps it will increase the amount of women who do self-exams. Maybe it will arm others with information to help loved ones who are affected by this common disease (about 1 in 8 women will get breast cancer at some time in their lives). Maybe it will spread hope. At the very least, writing helps me. And for now, that is enough.
Jacki Donaldson
leana - on March 25, 2008
Good for you - go for it. After gastric bypass I have saggy skin that exercise won't tighten and if I was younger, or had more money, I'd love to get rid of the saggy stuff, but will just try to live with it.My bikini days are long over and I just need to accept that I'm a pretty good looking 66 year old grandma and its okay.
You, on the other hand, are a pretty young woman and have a long life ahead of you - so best wishes on your surgery.
Jacki - on March 25, 2008
Thank you for your support. I really, really appreciate it.Jacki
ScrapAddict74 - on March 25, 2008
I know how you feel and swear if I had the money (and I didn't have cancer again) I would do it in a heartbeat!