One Year Later

One year ago today my life changed forever. On August 18, 2013 my life was (pretty much) normal. On August 19 when I got that phone call--"It is cancer," the nurse said--everything was different. I barely remember the days right after that, everything was very sad and very scary. But one year later I feel stronger and happier than ever. There have been bumps along the way, and the process isn't over yet, but the end is in sight and that is certainly worth celebrating.

The Update

I met with my reconstructive surgeon for the first time today since my tissue expander placement surgery on June 27, and was pleased that he thinks things are going well. The skin around the tissue expander is still very thin, and he said we will have to "take it slow" on the expansion, but overall it is definitely going in the right direction. We didn't set a date for my final surgery--much of that will be determined by how the expansion goes over the next few weeks--but it will likely be in October sometime.

The Changes

The past year has brought plenty of change, as I went from a healthy 31-year-old to a cancer patient, and now to a cancer survivor. I lost my hair, and now it's growing again (like a weed). It didn't even change color or grow in curly, it looks like it will be exactly the same as it was before. I gained weight and the change in hormones from the meds I'm on makes those stubborn pounds harder to lose. I have lost a good portion of my strength, and I'm a little bit nervous about going back to CrossFit, where I will likely be suffering through the WODs for a period of time while I gain that back. But overall I have also gained some perspective. I try to spend more time with the people I care about. I worry less about little things that might have otherwise bothered me before. I try to do what I can to make other people's days better, even if it's just in small ways. 

I recently had lunch with some college roommates, and one of them went through a scary pregnancy and had to undergo surgery for a potentially life-threatening condition (fortunately mom and baby are both doing well now). We discussed how the news of your own mortality is terrifying, but at the same time it really helps you to focus on what matters. I think I have always been a pretty positive, look-on-the-bright-side kind of person, but it always helps to have a reminder that life is short and every minute should be one that lifts you up, not one that you spend bringing yourself or others down. 

Another thing that has come into sharp focus is how amazing my friends and family are. I cannot tell you how many times it has brightened my day to have someone tell me they are thinking about me, praying for me, and hoping for the best. How many people have sent me messages, commented on blogs, or given me encouragement through Facebook, text, and in person. It makes a world of difference and I want to say thank you. And I would be remiss if I didn't mention Husband of the Year Nick, who has been my biggest supporter and cheerleader through the whole experience. Who never fails to make me smile, and who has always been there when I needed him most.

The Future

The best thing that has come out of the past year is my ability to look toward the future. One where I can get back to CrossFit (seriously, I'm going through withdrawals) and triathlons, where I can laugh and smile, spend time with friends and loved ones, and be thankful for every day that I get. I hope to be able to look back on this past year plus a couple of months and say "wow, what a crazy time, but I'm a better person for it."

We Begin Again...

Friday, June 27 was the date that reconstruction began again for me. If you've been following this blog since the beginning you probably already know that we tried to do "mastectomy with reconstruction" when I first had the tumor removed, meaning they placed a tissue expander at the mastectomy site right after the breast tissue was removed in the hopes of expanding the skin during chemotherapy. For a reason still unknown the incision at the mastectomy site would not heal after the surgery, and we had to remove the tissue expander so that I could move forward with chemotherapy.

Now that the chemo is all over (and I'm cancer-free), we are trying the tissue expander again. Going into this, there were essentially two options:

1. Get the tissue expander placed again, and hope that the incision heals normally. Since I'm not going through the trauma of a mastectomy or trying to fight off cancer this time around, there is hope that it will work without any other interventions.
2. The most likely culprit of the incision not healing was lack of blood flow at the incision site, so the doctor also said we could perform a "lat flap" procedure where they take a portion of my shoulder muscle and tunnel it through my body, bringing it around to the mastectomy site. It remains attached to the muscle in my back so it increases blood flow in the area. 

The second option is a much more invasive procedure, and would likely put some limitations on my range of motion and strength in the future when doing Olympic weightlifting, CrossFit, and triathlons, and for those reasons I decided that I wanted to try the first option again. There is no guarantee it will work, and if it doesn't then I go back for another surgery and we do Option 2.

So far the recovery has gone well, and it seem to be healing correctly. It's only five days after the surgery, so I'm not out of the woods yet, but I'm getting there.

As I am going through this, I also have a friend from high school who discovered that she carries the BRCA gene mutation, which puts her at a seriously high risk of developing breast cancer (I do not have the gene, which is good news for my other boob and for all the women I am related to). Many women in her family have lost their lives to the disease, and she made the courageous decision to get a preventive bilateral mastectomy. The reason I'm telling you this is that she did a TON of research into the mastectomy procedure and the reconstructive process, so I'll share links to her blog here in case you are curious about the medical side of the procedure.

Mastectomy 101 Part 1: Let's Talk About Nipples

Mastectomy 101 Part 2: Breast Reconstruction and Expansion

Mastectomy 101 Part 3: A Body That Will Never Be the Same

Mine is different from hers--I was unable to decide whether I would keep my nipples since my breast cancer tumor was very close to the nipple and it would be risky to leave the tissue (there could be residual cancer cells in the area). She is opting for a "nipple-sparing" mastectomy, while I had mine removed. I will probably eventually get a 3D tattoo that will resemble a real nipple. As she talks about in Part 3, my body will really never be the same. The best I can hope for is that both sides look pretty similar, and under my clothes people won't notice the difference.

Here's the hoping the healing process goes better this time around!

So...What's Next?

Whoa, it's been quite a while since I posted anything here. I hope you all didn't give up on the journey, it's just been a crazy couple of months trying to get back into the swing of things now that chemotherapy is over and it's back to "normal life."

While the chemotherapy is done, I'm not quite finished with everything yet, and the question that everyone has been asking is "so...what's next?" Here's the plan right now, as well as some info on the prognosis after a follow-up with the oncologist.

Step 1: Tissue Expander
You may recall from last October that I originally had a tissue expander placed when I got my mastectomy. The idea at the time was to have the tissue expander in place throughout chemotherapy, filling it every week or every other week, so that when chemo was done I would be ready or within a few weeks of being ready for my final reconstructive surgery. Unfortunately my body had different ideas, and after refusing to heal with the tissue expander (even after two more follow-up surgeries to try and clear out some of the dead skin that wasn't healing), we eventually had to take it out so I could move on with chemo.

Now that I have finished with chemotherapy, it's time to try again with the tissue expander. There are essentially two options:

1. Just try to put in the tissue expander again with no additional surgical tricks and see if my body will allow it to heal this time around. In this case the only area of my body that will be affected by the surgery is the site of the mastectomy where they will place the expander again. 
2. Put the tissue expander in and at the same time bring a portion of my lat muscle around from my back (leaving it attached to the muscle in my back), wrapping it around the area of the mastectomy in an effort to bring some additional blood flow to the area. In this case I will require some additional recovery because it will involve both the mastectomy site and my lat muscle.

When the mastectomy is performed, they remove a significant amount of tissue and leave behind only a small flap of skin. All the nerves and blood vessels are also removed at the time, which means that it can sometimes be difficult for the incision area to heal because you have very little blood flow in the area. 

We still don't know exactly why my body wouldn't heal with the tissue expander in place (although we do know that it didn't appear to be related to an infection), but the doctor's best guess is that it was because of the lack of blood flow. For that reason he was pushing me toward option #2. The down side to this option is, of course, that my range of motion and strength will be affected, which will have an impact on a lot of my hobbies, including CrossFit, triathlons (swimming), and Olympic weightlifting. For that reason, I have chosen to go ahead with option #1 and my surgery is scheduled for June 27. 

I fully understand that if things don't work out with option #1 again it will mean another surgery, and I will have to do option #2 anyway, but I really feel like I don't want to have those limitations unless it is an absolute last resort, and the only way I will know that it is a last resort is to try the other way first. In the end I will accept the limitations if required, and just work really hard to get back to where I was physically before all of this happened--heck, maybe I'll even try to get better than I was before. 

Step 2: Filling the Expander

No matter which option ends up working in the end, once the tissue expander is in place they will fill it over the course of about 8-12 weeks, stretching the skin until it is slightly larger than my other boob that was left intact. This is pretty straightforward, so not much to expound on here.

Step 3: Reconstructive Surgery, or "the boob job"

Once we get the skin stretched to a size that I like, the next step is to get the final reconstructive surgery. I will actually have an implant placed in both sides, the one at the mastectomy site will fill the whole breast and the one on the other side will just be big enough to make them even. The main reason for this is that it's difficult to get a reconstructed breast to look just like the real one, and an implant in both sides will make them look more similar. Depending on how long it takes to stretch the skin, I'm anticipating this surgery to be sometime in September/October.

Step 4: Follow-Ups

Of course, during and after all the reconstructive stuff there is the follow-up work to be done. I have already been in to the oncologist for my first follow-up appointment; he said that my blood work looked good and there was nothing abnormal about it. At that time he also prescribed Tamoxifen, an anti-estrogen drug that will help to keep my estrogen levels low for the next five years, which has been shown to help in curing breast cancer and preventing it from coming back. Since it's blocking estrogen chances are it will put me into menopause, but the oncologist thinks since I am so young I will likely come back out of menopause again after I'm done taking the pills.

I will continue to get follow-up appointments about every three months for the first year, then they will go to every six months and eventually to once a year. I'll have annual mammograms on the boob that I still have left, and we'll keep an eye on all kinds of things to make sure that I'm still healthy for many years to come.

I'll continue to keep you all updated as the surgeries progress.

Resolutions

New Year's is a time when many people decide to set resolutions, usually ones that are geared toward making yourself better in the year to come than you have been in years past. According to USA.gov, some of the most common resolutions people set include:

• Lose weight
• Quit smoking
• Get a better job
• Get a better education
• Save more money
• Eat healthier
• Get out of debt
• Spend more time with family
• Get organized
• Volunteer more
• Drink less alcohol

They all sound like great goals, and unfortunately they are also pretty vague, which is probably why only 8% of people are successful in achieving their resolutions every year, according to at study by the University of Scranton published in the Journal of Clinical Psychology. If you did make a resolution about being healthier, exercising more, etc., here is a motivational video that might help you. It was made by Rich Froning, 3-time CrossFit games champion (i.e. the "Fittest Man on Earth"). 

The most successful New Year's resolution I ever had was something like 10 or 11 years ago, when I made a resolution to floss every single day. I was successful in doing it for 21 days straight (which I hear is the threshold to make something a habit), and since that day I have rarely missed a day of flossing my teeth. My dentist is very proud. 

Before you think I am disparaging all resolutions, that is not the case. I also have set a goal with Nick to eat a healthier diet this year, and get back to CrossFit as much as I can during treatment and after this whole chemotherapy thing is all over. I believe setting goals can be a powerful motivator to keep us focused on the things we want to achieve. In that spirit, cancer and chemotherapy has also spurred a new resolution that will be ongoing every single day, every single year, from today until my time on this earth is over: live every day to the fullest, love more, hate less, and be thankful for every day that I get. 

The thing about being diagnosed with cancer is that, among other things, it makes you really think about your own mortality. I don't plan on dying from breast cancer, but when you hear that kind of diagnosis it makes you realize that any day on earth could be your last, whether you die of sickness, age, natural causes, an accident, or anything else. When I thought about that, I realized that every day is short. Every year is short. Every minute that we have to live should be a minute that we try to make ourselves, and the world around us, a better place to be. So instead of spending time thinking about how much you hate someone or something, being bitter about the past, hating your job, being mad at other people, complaining about life not being exactly the way you would like it to be, arguing and being petty, instead of that, spend more time loving, more time appreciating what you do have, more time working to make yourself the person you DO want to be, and more time letting those around you know how much you love them. I know I will. Happy New Year.