"Uh-oh"

I have never been to medical school, but if it's not already part of the curriculum, they should have a seminar on phrases that you should never say when you see a patient. Some things that I would recommend a doctor keep out of his or her vocabulary might include:

• "Gross" 
• "Uh-oh"
• "Oops"
• "That wasn't supposed to happen"

On Tuesday we went in to meet with the reconstructive surgeon to begin the next phase to rebuild me after the mastectomy, and he peeled off the glue that was holding the incision together after surgery (it was supposed to just start flaking off as it healed, but only a small part of the glue had come off by the third week). Starting Friday night and through the weekend the area around the incision had been leaking some fluid, but I was told that as long as there were no obvious signs of infection--fever, chills, redness and warmth that spreads--then it was probably okay. They said to keep it covered and clean, and they would look at it when I came in for the appointment. 

When we got there, the doctor peeled off the remaining glue and the first thing he said was "uh-oh." Yep, definitely not what I wanted to hear him say. He proceeded to explain that after a mastectomy, there is a very thin flap of skin left, which means it may have more difficulty getting proper blood supply. It turns out that in the immediate area around my incision, the skin wasn't getting enough blood, and it died.

The biggest risk after any surgery is the risk of infection, and with dead skin in the area, the chance of infection increases. With the tissue expander in place (the thing that is used to stretch the skin and prepare for an implant later), that risk can derail the whole process. As the surgeon explained, if bacteria get into the skin around the tissue expander, they attach to the plastic and are virtually impossible to excise without taking the tissue expander out altogether. In order to prevent infection, we had to go back into surgery to remove the dead skin and re-stitch the wound with just the healthy skin. 

The appointment was at 10:30 a.m., and fortunately I had not eaten anything since the night before, so they sent me directly to the surgical area of the hospital and told me to check in. It was supposed to be a quick outpatient procedure, and I was hopeful that we would be out of there by early afternoon. What they didn't mention was that since I was scheduled at the last minute, there were no operating rooms open until 5:00 or so. That meant sitting in the waiting area playing Candy Crush (we did leave for a couple of hours to run some errands) and trying to distract myself from feeling very hungry. 

Finally around 4:00 we went back into a pre-op room and by 5:30 there was an open room available. This time around they were able to do the procedure under MAC, or monitored anesthesia care, instead of general anesthesia. Instead of going all the way under, I remained conscious (although sedated with something to help me relax) and breathing on my own, and they just numbed the immediate area. It may seem weird to be awake during surgery, but they want you to be conscious enough to tell them if you are feeling any pain--if that happens, they put you all the way under. The anesthesiologist Rachel was really great, and we actually had a nice conversation during the procedure, which lasted about 45 minutes. They said the sedation affects your memory, but I recall quite a bit of our conversation about my family, her favorite restaurants (she recommended Per Noi Trattoria in Sugarhouse), and the best Broadway shows (I highly recommended Rock of Ages). 

When it was all over, I had a newly stitched wound and no more dead skin. It did set me back a couple of days on my recovery and getting back to work, but overall it will hopefully just be a little bump in the road to full recovery.

Barbells for Boobs

If you have spent more than about 15 minutes with me, you probably already know that I love CrossFit. I won't go so far to say that I am obsessed with it, but okay, I am obsessed with it. That has pretty much been the case since I first walked into CrossFit Cache Valley in October 2009 (now Cache Valley Strength & Conditioning) at the recommendation of a couple of friends. Since that time I've averaged about 5 workouts a week, and rarely miss more than a few days at a time.

In April 2010 when we moved away from Logan, I became one of the charter members of the newly opened CrossFit Timpanogos in Lehi, where I have since become a coach and generally love everyone and everything about that place. In October 2010 we found out about a fundraiser that some CrossFitters in California started for breast cancer awareness month called Barbells for Boobs (if you would like to find out more, or donate to the cause, you can do that here). Participants donate and complete the CF benchmark workout "Grace", and the money goes to a group called Mammograms in Action that helps women and men, who would otherwise not be able to afford it, get life-saving screenings like mammograms. Supporters can also donate without doing the workout.

I can always appreciate a good cause, and when it has a catchy name like Barbells for Boobs, and involves a CrossFit workout, I'm on board. Our small gym participated in the event the first year, had a good time, and we have participated in it every year since. We're never the gym that raises the most money, but we have been able to contribute a few thousand dollars over the years.

I had been thinking about the event during the summer, wondering when I should start planning for it, when I was myself diagnosed with breast cancer. Despite the obvious challenge of not really knowing what my next few months were going to be like, I knew we had to continue with the fundraiser. In fact, I figured I could probably exploit my condition to help raise a little bit more money for the cause. I even got a chance to go on KUTV and promote it in advance, with some help from a couple of amazing athletes from CF Timpanogos.

Just 5 days after my surgery, I was able to attend and see friends and strangers come out to support the cause. This year we had over 50 donors, and about 120 people who did the workout, which was an amazing turnout. I want to send out a special thanks to everyone who participated, and those involved in putting the event together, including our sponsors that donated prizes--CrossFit Timpanogos, Progenex, Gnarly Full-on Nutrition, Texas Roadhouse in Lehi, Anytime Fitness Tanning in Saratoga Springs, SexyModest Boutique, Ute CrossFit, and RidgeCrest Herbals.

True Love

Anyone who is married knows that it requires a significant amount of sacrifice, teamwork, and a lot of love to make a marriage work. That is especially true when one of you gets sick. I remember when I first got the news that I had cancer thinking that I was so glad it was me and not Nick. While I would have preferred that neither of us would ever have to go through something like this, having the cancer myself means that I at least feel a little bit in control. If it was Nick who was going through the same thing I would feel so helpless and out of control, wanting to be able to fix it but not being able to do so. I'm sure that is how he feels too, given the circumstances.

Fortunately when I got married, I picked the absolute best, most amazing, loving, and wonderful husband that anyone could ever be lucky enough to get, and he has been right by my side through this whole thing, providing the best care while I have been laid up. I was browsing through some breast cancer forums before the surgery to try and figure out what the recovery would be like, and remember stumbling across a post from a woman who was terrified of the surgery because she was concerned her husband was going to be upset with her for not being able to take care of the kids and the house. That seemed really devastating to me--not only to have to go through the trauma of cancer and surgery, but have the added stress of an unsupportive spouse on top of that. For me it was the exact opposite.

When you get a mastectomy, they put a couple of drains into your body at the incision site to help drain excess blood and fluids and prevent swelling and infection. The little tubes dangle from your side, and must be drained a couple of times each day. In addition to being kind of gross, and supremely annoying, they make most daily activities difficult, and they are in addition to the six-inch incision across my chest that was pretty painful. So it was that for two weeks I couldn't really get dressed, shower, brush my hair, cut my food, or even open the lid to the water bottle I brought home after surgery (seriously, they tell you to stay hydrated and give you a water bottle, but you can't even get the lid off...thanks a lot, hospital).

The great news is I have a great husband, and tons of other loving and supportive friends and family. From the first day that I returned home from the hospital, I had a constant stream of visitors, plus all the help I needed from Nick. In the hospital he spent the night on a pull-out "bed" that was about a foot shorter than his body, held the bucket for me while I threw up when I got nauseated from the surgery, and didn't care that I probably looked pretty horrific after a couple of days without a shower. Since we came home he has tirelessly helped with getting me dressed, undressed, and showered, and even learned how to blow-dry my hair when I couldn't do it on my own (despite the fact that Nick had never even held a blow dryer before this whole experience). He has cooked me food, woken up in the middle of the night to fetch me some pain medication or get the water bottle I couldn't reach from bed, and gone on walks around the neighborhood so I could get out of the house for a few minutes. He texts me from work to make sure I'm doing okay when I'm home alone, and hangs out with me all day on his days off.

I have always known that I have a great husband who is a ton of fun to be around, and makes my life happy, but after these two weeks I am more convinced than ever that I hit the true love jackpot.

D-Day: September 30

As September 30 was nearing, I couldn't help but feel like it was a sort of D-day for me. Please know that comparing my breast cancer journey to the day that troops stormed the beaches at Normandy in the fight against Nazi Germany is certainly not intended to minimize or make light of what soldiers went through on that terrible day (more than 9,000 soldiers were either killed or wounded). But that operation was what General Dwight D. Eisenhower called a crusade where "we will accept nothing less than full victory." It wasn't the end of the war by any means, but it was a critical part of the battle that turned the tide in favor of the Allied forces.

The hard thing about cancer is that surgery, while a major undertaking, is really just the beginning of the battle. It's an important step down the road to recovery, but it is certainly not the end. And in my case, it was the beginning of a crusade where I will accept nothing less than full victory.

So I reported to Huntsman Cancer Hospital on September 30 to say goodbye to one of my boobs forever. It's certainly a strange feeling knowing that when you wake up part of you will be missing, but it is a necessary casualty in my own personal war.

After a quick meeting with the anesthesiologist (I had been suffering from a pretty bad cold and cough the previous week, so they sent in the anesthesiologist to make sure it would still be safe to put me under for the procedure), and some time with the plastic surgeon, I made my way to the "Nuclear Medicine" wing of the hospital. Inside a small room, there was a needle next to a container that said something to the effect of DANGER on the outside, and the surgeon explained that it was radioactive material that they were going to inject into me. So, yeah, great. They store it in a lead container and nobody wants to touch it because it's potentially dangerous, and they are about to inject it right into my body. Supposedly it's a low dose of radiation and I'm going to be fine, but once that shot is in, I'm officially nuclear.

The radioactive material is actually designed to travel to my lymph nodes, the same path that potential cancer cells might travel if they had escaped the immediate area of the tumor and decided to go somewhere else in my body. According to the surgeon, there is no specific pathway that they follow, but finding cancer cells present in the lymph nodes indicates that they may have spread elsewhere. The radioactive injection helps the surgeon find the first few lymph nodes that drain from the breast tissue, thus enabling them to do a quick biopsy of those nodes while I'm already in surgery. If they find cancer cells present, they take out the lymph nodes and can either biopsy more, or take out more in the area.

It was supposed to take 2-3 hours for this material to drain into my lymph nodes, during which time I expected to be miserably hungry and thirsty (since it was close to 11:00 by then and I hadn't eaten since midnight the previous night), but it was only about 30 minutes before the surgeon came in to go over a final few notes before the procedure, then maybe another 15 minutes or so before the anesthesiologist came in to get me and take me away. During our pre-op meeting the surgeon also took a few seconds to write "yes" on the right breast in marker, just to make sure he took out the right one, he said. I hadn't really considered the possibility of getting out of surgery to find that they had taken the wrong breast out, but that seems like it would be pretty horrific. I'm glad he gave himself this little reminder.

Once in the operating room, it only took a few minutes before they gave me the anesthesia, and the next thing I remember is waking up in the recovery room around 2:30. Apparently everything went as planned (he took out the correct breast), and after an hour or so in recovery I was taken to a hospital room for the night.

First let me say that I am very grateful for the exceptional care provided by all the nurses and aides who were at the Huntsman Cancer Hospital that night. They really were great. That said, spending the night in the hospital is miserable.

I was exhausted and in some pain, nauseated from coming out of anesthesia, and really all I wanted to do was sleep. That turned out to be impossible because of the constant activity level inside the room. I don't think we were left alone in the room for more than about 60 minutes at a time all night. Between aides coming in to take my vitals, nurses coming in to check if I needed anything, and surgeons coming in to discuss the results of the procedure, check my incision, and give me instructions for when I headed home (they do this before surgery, so they started coming in around 5:30 or 6:00 a.m., and I had several different surgeons and residents visit me because I got both the mastectomy and a tissue expander to start reconstructive surgery), I probably got a total of 3 hours of sleep that night.

There was even a time around 3:00 in the morning when one of the aides came in to tell me that she would no longer be my aide, and introduce me to the new person who would take over. Let's be honest--I'm on pain meds, delirious from lack of sleep, it's 3 a.m., and I really don't care who shows up to take my vitals. Whoever shows up, I'm going to assume they are the right person to do it, and it really doesn't require waking me up in the middle of the night just to tell me someone else is going to do it, then telling me that person will be back to wake me up again in an hour for said vitals.

Fortunately mastectomy surgery only requires a 1-2 day stay in the hospital, and the next morning they encouraged me to try and get out of bed and walk around the hospital wing at least 3-4 times that day. The first walk was just to the bathroom, and the next one was a little shaky, but by walk #4 I felt pretty good and was eager to get discharged. We found the surgeon and were able to get permission to leave and go home for a real night's sleep.

Caught Up in a Whirlwind

Probably one of the most difficult things whenever we face a big challenge or trial is the sheer volume of information and activity that happens in the wake of devastating news. I remember the week after my dad died five years ago, there was so much that had to be done, and it all had to be done quickly despite the fact that our whole family was completely overwhelmed. It would have been much easier to just lay down and cry than to spend time organizing a funeral, hosting friends and family who were coming to offer their support, and figuring out the final arrangements for his cremation.

Hearing the news about cancer sort of felt the same way. One the one hand, it would be much easier to just sit down and cry (and believe me, I did plenty of that for a couple of days), but there is so much that has to be done to figure out treatment, and it can't really wait. The next two weeks following my diagnosis were a whirlwind of appointments, consultations, and meetings with surgeons, oncologists, nurses, and other care providers.

I have never really been the type of person who actively sought medical treatment, and prior to August 2013 could probably count on two hands the number of times in my adult life that I have been to a doctor for something besides a routine physical. That all changed with my diagnosis, and from August 14 (the day of the mammogram and biopsy) to mid-September, I'm sure I had more tests, appointments, and scans than I have had pretty much ever.

The most important and pressing matter was to figure out what kind of surgery I wanted to do. Essentially, there are two options:
(1) A lumpectomy, where the surgeon removes only the tumor and some surrounding tissue, in an attempt to save as much of the breast tissue as possible.
(2) A mastectomy, where the surgeon removes all the breast tissue on one or both sides.

Given that my tumor had only shown up on one side, it wouldn't make much sense to do a bilateral mastectomy, so the choice was then down to a lumpectomy or a unilateral mastectomy on the right side. We sat through several doctor's visits learning all the options, as well as the projected outcomes and the potential for a cure. I spent way too much time on the internet researching all the pros and cons for each choice. I even found a YouTube video of a mastectomy surgery, and watched about 30 seconds of that before I had to turn it off (apparently it's good I didn't try to become a surgeon, since it made me a little queasy to watch).

During this time we also decided to go and get a second opinion at the Huntsman Cancer Institute and find out if I wanted to get treatment there instead of through IHC. While I am confident that both places could have provided good care, after meeting with Dr. Nelson (the surgical oncologist) and Dr. Agarwal (the reconstructive surgeon) at Huntsman, the choice to get treatment there was clearly the best choice for me.

After a few more tests, scans, pathology reports, and biopsies, Dr. Nelson explained that I was not a perfect candidate for either surgery choice--the perfect candidate for a lumpectomy is someone with a very small tumor and/or very large breasts, while the perfect candidate for a mastectomy is someone with a very large tumor and/or very small breasts. I had a medium-size tumor with basically average-size breasts. Armed with all this information, I decided to go ahead with a unilateral mastectomy, and the surgery date was set for September 30.