Monday, January 28, 2013

Game Day!

Put on your game face...and jump in!  Despite how much my brain tells me that this is the logical way to proceed, I still had the jitters.  A last email to my plastic surgeon asking about the pros and cons to a direct-to-implant (one-step) surgery.  He explained that sometimes the condition and thinness of the skin doesn't make it easy to put in a full implant and said that the best candidates are for women who already have stretched skin from a prior implant or women who wish to go a smaller size than they are.  He thought the expanders would be the best way to go for me.  I agree... just jitters.  He reassured me that I'll do just great in surgery!
Prior to my surgery, the hospital called with instructions that I was to call at 3pm the day prior surgery to find out what time I would need to report at the hospital.  (I ended up needing to be there at 6:30am)  The nurse said I should not eat past midnight and only have water, soda or coffee up to 4 am.  I should shower the day of surgery with an antibiotic soap.  I should bring loose pants and a shirt that buttons up the front.
So, Nana and Papa came to stay the night to help with the kids and school and we slept at their home just minutes away from the hospital.
Here I am pre-surgery before meeting with the general surgeon, Dr. Reading; the plastic surgeon, Dr. Ferguson; and the anesthesiologis, Dr. Bowman.
Post surgery...let's just say I was in lala land for a while and I hurt a lot!  The Dilaudid that they gave me IV for pain every 4 hours was wonderful.  I wish I could've taken that home with me.  I was sent home with pain meds (percocet every 4 hours), but they didn't cover the pain like that IV drug!  I was sent home with an antibiotic as well (every 8 hours).  It was suggested that I take a probiotic at home too.  I also am drinking a glass of Miralax a day (gift from a caring neighbor:)
 Here Dallin, a nice patient assistant is draining my drains.  I will have these in for about a week if there isn't too much fluid draining after too long.
 This is a picture of my new bra!  It is stuffed with gauze and is super tight.  I wasn't allowed to remove the bra for 3 days.  The drains are taped to my sides and are embedded inside my breasts to relieve the fluids.  I measure the output of fluids in my drains twice a day.
Today is Monday and I had the surgery on Thursday.  Last night I didn't take any pain meds throuout the night.  I feel discomfort, but not the unbearable pain anymore.  I think I'll just stop taking the pain meds for now.  I anticipated feeling a lot of pain for a lot longer.
 This is what I wrote while in the hospital:

Arm tired. Hard to write...
6:30am arrive at IMC to check in
Peggy was RN who dressed me and started IV. really nice
Dr. Ferguson came in to see if I had any questions. picture (He drew blue marker lines all around my breasts and where the incision would be)
Dr.Reading came in to see if I had questions
Dr. Bowman anesth came in- he walked me to the OR after I kissed Dan
I walked right into the OR room and got up on the bed, laid down and had my arms laid out on the tables on either side of me, like a cross.  I think they strapped down my arms.  I remember Dr. Readins's smiling face.  I said, "Before I am knocked out, I just want to thank you all..." Dr. Reading explained, "No problem, that's why we're here.  Happy to be here..."
I remember waking up in PACU recovery, well, not really waking up.  I was so groggy and vaguely remember being wheeled in my bed to my room-lots of bumps. Then Dan was here...I was in and out.  He helped me to eat some food.  I couldn't eat very much.  He went to say hi to the kids and get his clothes for his presentation the next day.
Adam came to visit me at 11pm-Thank goodness!  He saved me last night!  I seriously thought I would be okay by myself-Adam is so wonderful!  He handsanitized my hands, scratched my itches, held my barf bucket, emptied my urine measuring cup in the toilet, fed me meals, fed me drugs, adjusted my bed, put on and took off my covers, put on and off my leg pressure cuffs, helped me out of bed to go potty, swept the hair from myeyes, was my pain management advocate and kept my comapny with his sotries and observations.  I asked him if he'd spend the night with me in the hospital and he was so quickly willing and genuinely happy to do so.  With every gesture, he served me with a happy, willing heart.  It would've been an awefully difficult night without Adam.  Instead, it was a wonderful chance to connect with my little brother.
Dr. Ferguson came in the next morning to give me instructions:
Drain 2X day and measure.  Meet him in clinic in 1 week and if I've drained enought, then he will pull my drians (should gradually go from bloody, to straw, to clear).  He said since my torso and peck muscles are long, he was able to go in lower and cut less into my muscle.  He said I have very thin skin and he only would fill the spacer with 60ccs so to give a little room for healing so it's not too tight. He'll see if he can fill more on Friday.
dan came to visit before his presentation.  Adam ran out to get a bite to eat.
So grateful that all went well.  Last night it was so painful and so hard to move my arms and walk to the bathroom.  It's getting easier to day.  Hopeful it will just keep getting easier!

My sweet email buddy Marge, emailed me and told me to make sure I maintain a positive attitude...just allow the house to be a mess for a few weeks.  She said after 4 weeks she was able to pick up around the house.

 I have had some wonderful family and friends help me through this.  Friends have brought meals and offered to take my children for playdates. Last night, Adam helped me prep our dinner meal and Leslie and Preston helped to sweep and clean up my kitchen and they all helped me get my trash out.  Goodness I am blessed to have such lovely people around me!

Monday, January 14, 2013

Breast MRI Imaging pre-surgery

Thursday was my breast MRI that Dr. Reading, my general surgeon, ordered to make sure there were no "surprises" before my preventative mastectomy next week.  (I can't believe it's next week already!)
I have never had an MRI before and it was an interesting process...including a needle stick.

So, I went to Intermountain Medical and checked in on the computer, took a pager and had a seat in the waiting room.  I was buzzed and was processed through.  It kind of hurt to hand over my credit card to pay the $1600 due for the MRI.  I think it cost over $2000, but perhaps because I have a high deductible, they give me a discount. I should be hitting my deductible by the end of the month with the upcoming surgery.  As I handed over my credit card, I thought about an earlier text from my husband:

Me: IMC called and said the MRI will be $1600.  Sorry that I'm costing so much.
Dan: Don't worry about it, Babe.  Your love is priceless to me!

Love that guy!

When I was called back, I was given pants and a hospital gown to change into.  I had to remove all metal from my body.  The MRI tech was really nice.  She said she's been doing MRIs for 10 years now.  We were talking and I mentioned she must have seen a lot of "boobies" after 10 years.  She said that the techs often comment to each other on which physicians seem to do the best work.  I asked what her opinion is of Dr. Ferguson's work.  She told me she thought that he does a really good job, so I was encouraged.  She seemed sincere.

The tech started an IV into my arm so she could inject a contrast to be able to image my breasts.  I laid on my belly on a narrow table that stuck out from the MRI time-warp-looking-portal-spinner machine.  There was a long piece where I rested my sternum, and then there was a lack of table where my breasts would hang down on either side.  The tech said that this position allows more breast than chest to be imaged.  I rested my arms above my head  The bed retracted into the big cylinder ...and I HELD STILL... for about a half an hour or so.  The machine made loud banging noises and beeping patterns.  At moments, the tech would speak to me through some speaker inside the MRI machine, "You're doing great.  Now there will be a 2 minute sequence."

After I was transported out of the MRI machine, I asked the tech if she would snap a photo of me on my phone.  She stood far outside the MRI room.  I asked her to come a little closer...and she reminded me that no metal is allowed in the room and that my phone would be messed up if it got closer to the machine.

Now to find out the results....hope that I'm clear!

Saturday, January 5, 2013

Jan 24th

The date is set.  People ask if I'm still going through with the surgery while Mom is in the state she is...and I feel the determination to reduce my risk even more than before.  I go in for a breast MRI next week to "make sure there are no surprises", as Dr. Reading puts it.  I am immensely grateful that we have been able to bring four children into our home before I have had signs of cancer.  I am grateful to be able to have these surgeries before I have gotten cancer.  In my mind there still looms the fear that BRCA2 holds more than just the cancer threats we know about.  All I can say is that I'm doing all that I can do.

We have decided to go with a radial incision, slightly sloping downward from my nipple out.  I have spoken with a few other ladies who had an under-breast incision so it's kind of hidden from a bird's-eye view.  It seems the under-breast incision would be more aesthetic... I emailed Dr. Ferguson again in hessitation:

"Hello Dr. Ferguson!

I am preparing for my upcoming mastectomy and reconstruction on January 24th and am grateful that you are going to perform the reconstruction. I trust you and know you will do a beautiful job.

I know we talked about not doing an under-the-breast incision and instead doing the incision sloping downward and outward from my nipple.

If you don't mind, I just need a quick little reminder as to why the under-the-breast incision isn't preferred. I know we talked about the weight of the implant resting on the incision.

I am also wondering if you have performed an under-the-breast incision reconstruction before and what the results were.

Ultimately my husband says not to worry about the incision placement, but I would love one more reassurance from you.

Thank you for indulging my last minute jitters,"

"Please, now I feel that you are going to do great regardless of where the incision is. Yes, I have performed reconstruction with both approaches. My personal preference is for the lateral oblique incision. My reasons for this are both with the reconstruction and the mastectomy. One reason is that if the incision is at the most dependent portion of the breast, then all of the implant weight will be on the weakest area of the skin. If I do need to use Alloderm for the lower hemisphere reconstruction, then the Alloderm will be directly below an incision repair in a very thin person rather than her own vascular tissue (such as muscle). When I go back to change the expander for an implant, I am going to cut through that repair (whether Alloderm or muscle) and again open a weak area. The other concern is blood flow to the nipple. In my opinion, there is more potential for compromise to the nipple with an incision that cuts perpendicular to a blood flow route through the skin to the nipple. While not entirely the same, if you picture the nipple as the center and all vessels going to and from it like spokes on a wheel, a transverse cut under the breast goes perpendicular (or across) the routes from the lower part of the breast. An oblique lateral would be parallel to the routes and theoretically disrupt fewer blood flow routes. Either approach has potential for nipple necrosis, however looking at mapping of angiosomes or blood flow patterns of the chest skin, the lateral incision makes more sense to me. Another potential benefit (which would be more for Dr. Reading to decide) is access for the mastectomy. The distance from the lowest portion of the breast to the highest portion in most people is greater than the distance from the most medial (central) point of the oblique incision and all other points of the breast. For some women, the downside is that they can see the incision repair more readily than if it is below the breast. I think in your breast shape when you look in a mirror you will be able to see the lower breast incision readily but not as readily from a bird’s eye view (looking down without the aid of a mirror).
I am fine with whichever incision you prefer. These are the reasons I personally prefer the oblique. I think that you would be a candidate for either one.
Hopefully this was helpful,"
His explanation makes so much sense...  What to do!

So Fast

From November to the beginning of January... that's no time at all.  We had a fully functioning, grab-life-and-live-it Mother and so quickly Mom slowed down.  At first, as far as I noticed, it was more difficult for her to do things she wanted to do because of the mini-stroke/tumor pushing on her brain.  She was tired more easily as we went on outings and we helped more around her home.  She had a shorter patience span, she was easily emotional and she would go upstairs to rest soon after Sunday dinner.  All of these things contributed to her frustration with the situation.  Eventually, Mom was more and more frightened that her declining health wouldn't improve and that's when the gradual and then more obvious depression set in.  You can only feed yourself positive thoughts for so long ...  before you can't. 

Now when I visit Mom, she lays on the recliner, still trying to keep herself busy as she knits winter caps for her grandchildren on a big circle loom.  As I sat talking with her, she looped yarn around each knob.  Often, six or seven loops would twirl backwards undone before she could stop the undoing.  You could see that each movement was slow and deliberate.  These hats are filled with determination and love.

Adam and I helped take down their Christmas tree.  Mom had decided that she wanted a real tree this year.  Maybe because we had never had a real tree in our family, and this was another way of experiencing a new aspect of life.  We removed each white angel ornament from the tree.  Mom loves angels.  Then we swept off the years-old tinsel that hung on each branch.  From the time I remember Christmas, I remember tinsel on the tree.  Pine needles scattered the carpet and from her armchair, Mom was directing the show, letting us know what to do next and how to clean up.

Mom has lost so much weight because it's all she can do to sip a cup of tea each day.  One day as I rested my hand on her knee to lean in for a kiss, I was shockedly surprised to feel how thin andy bony her leg had become under her loose clothing.  Dad's taken her several times to the ER to be hydrated with IVs.  She feels too nauseous from smells and food to eat.

Dad is amazing as always.  He is so devoted to Mom.  He cares for Mom and makes sure she gets out of bed.  He takes her to her medical appointments up at Huntsman Cancer Institute and races her into the ER for hydration.  It must be so emotionally difficult to watch your sweetheart die.  Dad always has told Mom how much he loves her and calls her "Beautiful".  Mom let us children know that she wants us to be accepting of Dad remarrying and that she wants that for him so he's not alone.

I am grateful that they moved here two years ago so we could spend time together and so Dad has support from us now too.  Adam decided to move home for a few months to be with family and attend school.  It's been helpful to have Adam in their home... helping and distracting Mom from her daily situation.

Mom says that "If this is what it's going to be like, then I just want to die."  It's hard to watch her feel such sorrow and pain.  Dad and I just purchased plots at the new cemetary the first day they went on sale and we feel blessed to have such a close place to visit her grave.  I always thought I'd be so much older when Mom and Dad died.  This whole process scares me as I watched Teresa, Mom's sister, die from  metastasized ovarian cancer and go through a lot of the same process.  They said that at the end of her life, Teresa reached up and said "Let's go".  I am frightened that my BRCA2 will put my husband and children through this difficult re-run.  I am more and more grateful for my Savior and his deep love for all of us, that he would be crucified and overcome death.  The Resurrection is a beautiful gift and I look forward to my mother being able to embrace and enjoy a resurrected and perfected body.  How can our Heavenly Father be so wise, caring and loving of each of us?  He has prepared such a beautiful life for us on earth and after if we just follow His Plan.

I hesitate to know how these next few weeks will play out.  Dr. Ward said she probably has only a week or so more to live.  How will our lives be measured?  How will each of us be remembered?  Mom and I had a conversation a few weeks ago as I taped some of her memories.  I told her my greatest desire right now is to be a more patient wife and mother.  I feel the urgency of nurturing a loving atmosphere at home and appreciating little gifts of love we share as a family.  Creating memories together.  This is how I want to be remembered. 

Perhaps my last "best" memory of my Mother will be when I visited her while she was hooked up to hydration IVs last week.  I brought her two gifts, wrapped in paper with beautiful white ribbon bows.  The first book was a photobook of our family photos we took recently.  There were beautiful photos of Mom and Dad together... and all of us.  Then, I read the second book to Mom while she listened.  It was about the Candy Bomber in WWII, Mercedes and the Chocolate Pilot.  I had recently been able to get last minute tickets for her to attend the Tabernacle Christmas Concert.  She had reminded all of us to sign up for the tickets in hopes one of us would get them.  The Candy Bomber made a surprise appearance amidst hundreds of tiny parachutes raining down chocolate on the audience! It was such a spectacular moment for Mom and Dad.  It was fun to read the book to Mom, Dad and Adam and laugh at each funny part and tear-up at the touching words.  That's a beautiful memory I'll cherish.