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Saturday, October 3, 2009

Bad News of the Best Sort

We met with the plastic surgeon, Dr. Welch, on Friday. There was ever so much to discuss. And discuss we did.

For starters, I love Dr. Welch's Physician's Assistant. I've blanked on her name. I'm horrible with names under the best of circumstances, but lately, chemo brain has made my ability to even remember what people look like worse than normal. My ability to grasp names is much worse than normal. In fact, I worry about my ability to function normally in the future.

The PA took my history. I'm a slow learner, but I have finally figured out that instead of tediously copying down all the supplements I take, I could just give the doctors a copy of the list. The chemo has been highly effective so far, as discussed earlier, and for that I'm thankful. However, I think at least some of the success has to be due to the incredible research Katherine in Atlanta has done, and the regime of supplements she developed for me, which I take on a semi-religious basis. When the PA saw my list, she was quite impressed by the cutting edge nature of it. In fact, recently, I skimmed the book (which I highly recommend for all who would like to reduce the incredible odds of getting cancer--just living in the USA increases your risk these days) Anti-Cancer by Dr. David Servan-Schreiber and noticed that Kat in Atl's list of supplements is very similar to what he recommends. While none of my other doctors have pooh-poohed my supplements, neither have any of them actively encouraged their use. Her affirmation set a very positive tone.

Dr. Welch is the epitome of energetic. Ever seen an electrical arc? That's her. She burst through the door of the room, and bam, we were talking. After carefully talking through how my philosophical tendency would be to use my own tissue for reconstruction, she was also very considerate of my concerns regarding recuperation times, the effect on my family of such major surgery (10-15 hours), and danger of a 6-8 day hospital stay with drains in my body (ideal entry for MRSA). Who has a planned stay in the hospital of 6-8 days any more? Not to mention a difficult 8-10 week recovery. We also discussed the pros and cons of implants, current research on implants, her experiences with implants, as well as procedures, recovery, and risks.

All of these decisions and her job as an artist of flesh is compounded by the fact that the left side of my chest will be radiated for 8 weeks prior to the reconstruction. While radiation kills those lingering cancer cells, it's really not a Good Thing (tm) for the human body. Ultimately, having to go through radiation means that the reconstruction can NOT be done at the time of removal. By the time we were finished talking, we had left it that I would have my mastectomy in December, have a temporary expander put in, and then later decide what type of reconstruction to have: some sort of "flap" (own tissue) or implants later on. At that time, my prophylactic mastectomy would be done and reconstructed.

It felt good to have a plan. Then Dr. Welch examined me and I got the best bad news I've ever gotten.

I'm not large enough to use my own tissue for reconstruction.

That's ultimately good news for two reasons: (1) I never thought I'd hear that I'm too thin for something. Dr. Welch thinks there isn't enough tissue in my abdomen to build more than one A-cup size breast. One doesn't go me much good. (2) Knowing I didn't have to decide for or against that type of reconstruction and the risks inherent with it, was like a 10-ton weight lifting off my shoulders. I didn't want to face that surgery. But I also didn't want to discount it and chicken out because I'm afraid of the recovery. Plus, I was concerned that no matter how I decided, I'd have regrets. Now, there is no decision. I can't do it. It's not possible. End of story. 'Nuf said. If the radiated side needs to be "fleshed out" later on, due to skin contraction as a result of radiation, I have enough tissue to do that.

Therefore, as it stands, I'll have surgery sometime around mid-December. I still need to decided whether to have both breasts removed at that time or just the one. Then 8 weeks of radiation. And sometime in early Spring, reconstruction.

I'm leaning toward having both breasts removed in December. There are a few reasons for this. (1) if I need to have a tissue expander on the right (prophylactic) side, if I have it done later, I have to then wait for reconstruction. (2) Surgery costs money and if I have both done in December, then it will ultimately be cheaper. (3) My right side is my dominant side. My left arm is already quite a bit weaker and less coordinated than my right arm. For instance, if I try to brush my teeth with my left hand, I practically stick the toothbrush up my nose. I'm afraid I'll have a much harder time re-gaining strength and mobility with my left arm if I can easily overcompensate with my right. And then where will I be when I have the right side removed? I think, perhaps, I could better achieve symmetry if I just do both sides at the same time.

Monday or Tuesday, I call and schedule round one of surgery. It feels good to have some sort of plan, even if it isn't all finalized. I feel like a huge weight has been lifted.

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