F*** Cancer

When I started my cancer journey in March, 2023, of the things I was most curious about was how cancer treatments would affect my hair–and one of the first things my oncologist told me was I would lose it.

I’m now finished my cancer treatments (details of which I will save for another post). My last chemo treatment was last August, and my hair has been slowly but surely making a comeback–subsequent anti-cancer drugs I’ve been given do not provoke hair loss. I now have a full head of hair, and my eyebrows, eyelashes, and that random rogue chin hair are all back as well. The hair that’s grown in, however, is very different from what I had before treatment.

This element of the cancer journey is definitely best as a show, not tell, narrative. Click on the image to open and zoom.

Two weeks ago, my right breast was removed. This procedure feels like the pinnacle of this journey (I certainly hope it’s the pinnacle, at any rate). My recovery is going very well, but it’s taken me a while to feel ready to write it up. We’re here now, though, so here we go!

The Pre-op process

In the weeks before my surgery, I had several pre-op hospital visits:

1. I met with my oncology surgeon to discuss the options and decided on a total mastectomy of the right breast.
2. I had an MRI to verify the results of chemo and make sure there were no new sites of interest.
3. I met with my plastic surgeon to discuss his role on the day of surgery, and what my options are for reconstruction.
4. I met with a nurse from the breast clinic to discuss the recovery process and how to take care of my dressing and drains.
5. I met with a general practitioner and another nurse to discuss my overall health and get the green light for surgery. In that same visit, I had comprehensive bloodwork done. My blood type, fittingly, is A+

Day of Surgery

The day of surgery was one of those days in which time seems to move at an inconsistent pace. From start to finish—leaving home to returning home—the process took about 11 hours total:

10:30 Leave for the hospital. Try not to take anxiety out on other drivers who probably aren’t aware that I’m headed in for surgery and therefore they should just pull over and give me priority.

11:00 Check in. I’m given two gowns. I have to remove all clothing (all jewelry as well, but all of my piercings were already out for the MRI). The first gown goes on like the hospital gown as seen on TV, with the opening at the back. The second gown goes on like a bathrobe, opening at the front, presumably in a wildly unsuccessful attempt at preserving one’s dignity. I’m wearing paper slippers and have no eyebrows; the dignity ship has sailed.

11:30 Pre-op check up. A nurse interviews me (by the way, I lost count of the number of people who made me confirm that we were removing my right breast), takes my blood pressure, and more blood. She confirms that I have been fasting since before midnight.

12:30 Pre-op artistic expression. The plastic surgeon uses a Sharpie to draw what I assume are guidelines all over my chest. We confirm once again that it’s the right breast. I am surprised that he doesn’t draw a giant X over the left one, just to be sure.

2:00 Transfer to (close to the) OR. I am taken by wheelchair (no walking!) and then helped onto a gurney in a hallway right outside the operating room. I am introduced to my anesthetist, his intern, a surgical fellow, another resident, and probably a few dozen more people. All of them are wearing masks and ask me the same questions (I’ve been fasting, yes it’s the right breast, no I’m not nervous, no I’ve never had general anesthetic before, etc., etc.) so really I have no recollection of any one member of the team, although I do remember that the surgical fellow had stunning eyebrows. My oncology surgeon comes out into the hallway to go over the procedure once more. He notes the tattoo I have on my left ring finger, and says it’s a great idea and that he’s lost his wedding ring twice by forgetting it in the pocket of his scrubs. “So not in a patient, then?” I said, which led to several minutes of us sharing our favourite Seinfeld moments, culminating in us simultaneously shouting “master of my domain!” Someone places intermittent compression sleeves on my legs.

2:30 (ish) Actual transfer to the OR. I get up on the operating table, where my perspective is somewhat limited. There are massive lights overhead, and I can hear, but not see, a lot of activity nearby. My gowns are removed but modesty preserved under a blanket. Pat Benatar’s “Hit me with your best shot” is playing. The anesthetist gives me a shot to numb my hand, then sets up the IV anesthetic…

6:45 (ish) Recovery room. I wake up in a completely different place, with a recovery nurse nearby. Over the next hour, she helps me slowly get back to full consciousness. She raises the bed a little bit at a time, offers me ice (I woke up into a full-blown hot flash. Have I mentioned that menopause sucks?), gives me a sip of juice, and a cold washcloth for my head (seriously, I was burning up). Eventually she removes the compression sleeves, which by this point are so covered in sweat that they practically slide off. Apparently, this is all completely irregular, because most people wake up from general anesthetic feeling cold, not hot.

7:30 Still the recovery room. My husband is brought in from the waiting room to entertain me while I’m still under post-op observation. He entertains me by playing Scrabble on his phone, mostly. In his defense, I was not at my best, conversation-wise.

8:30 All clear. We’re given the green light to go home, although I am confined to the wheelchair until we get to the car. I guess once you’re in the car, you’re somebody else’s problem.

9:00 Home. Ten hours later, I am home, minus one breast (pretty sure it was the right one). I still haven’t eaten in about 25 hours at this point, so Andrew makes me some Bovril, which comes back up about an hour later.

10:00 Bedtime. You would think that a few hours under general anesthetic would mean a sleepless night, but you would be wrong.

Recovery

I came home with a Jackson-Pratt drain, which aids healing by draining fluid from the incision. So for two weeks, I had a tube emerging from my side, a few inches below my armpit. The other end of the tube is a rubber bulb into which the fluid drains. While the drain was in place, I had to empty the bulb three times a day, and record how much fluid was collected. I also had to “milk the tube” to ensure that the tube was always open and fluid could travel to the bulb. My only regret is not having a deep enough knowledge of obscure sci-fi to come up with an appropriate allusion.

I also came home with two prescriptions: ten days of preventive antibiotics, and some high-end painkillers to be taken as needed. I think my paranoia about the opiate epidemic must be strong, because after one day, I eschewed the painkillers—thankfully, the pain was not intense. I took one painkiller just before bed two or three days post-op, mainly because my back was sore from sleeping in an unfamiliar position (avoiding the drain and incision site meant sleeping on my back, and exclusively on my left side after the first night).

There were two aspects to recovery that were annoying, even though things went smoothly. First, I was not allowed to shower or bathe while the drain was in place. For someone with multiple hot flashes and night sweats, this was a tough directive, but I followed it. I was hoping that the drain would come out when I went in on Recovery Day 10, but there was still enough fluid collecting to warrant another few days. The drain was removed on Day 14, exactly two weeks after the surgery, and everything looks like it’s healing very well, so I guess it was worth it. But still. Ugh.

The other annoying aspect is the general lack of mobility and comfort. Thankfully, years of yoga prepared me for this recovery, and my range of motion in the right shoulder is almost 100% already. I have gone for a few short walks since the surgery, but it’s not very comfortable to walk briskly without a sports bra, and the thought of a bra right now is very off-putting, since the major incision is precisely where a bra chest band sits. So I’m wearing camisoles with loose built-in bras, or tanks with no extra support. There are two smaller incisions under my arm, where the oncology surgeon removed lymph nodes for testing (the tests came back negative, so my lymph system is otherwise intact). I’m not allowed to drive for another week, but I’m fine with that given that our pothole-infested infrastructure is jostling enough when I’m a passenger with both hands free to clutch my chest.

During the surgery, the plastic surgeon put a tissue expander in place. The expander means that for now, my right breast is smaller than the left; over time, the plastic surgeon will add saline to the expander so that my skin stretches to accommodate the actual implant. I will have a second surgery to swap the expander for an implant, sometime next year. For now, I have a fake fake boob. Also, since the implant will sit higher than my old boob, my plastic surgeon will have to give the left one a lift. Darn it.

Under clothing, it’s hard to see any difference, especially if I’m wearing a camisole with some support. Bare-chested, it’s clear that there’s something not quite ‘normal’ about my right breast. My nipple is still there, which helps the visual. There is a large incision under my breast, already healing nicely. The breast itself is visibly lumpy, which is disconcerting. I assume that as the expander is filled, the breast will become more breasty.

I have some sensation on the sides of the breast, but none in the nipple or the surrounding area. My plastic surgeon was impressed with how much sensation I do have, so it’s possible that over time it will get even better. Thankfully, I rarely rely on my breasts to sense my way around, so I’m fine either way (and you’re welcome for that visual).

I will see both my medical oncologist and oncology surgeon in November, and map out the rest of my treatment plan. The negative results from the lymph nodes are a very good sign, and I’m optimistic that I won’t need radiation.

The important part

While I was under the anesthetic, my oncology surgeon called my husband to report that everything had gone well, and that as far as he was concerned, I am now cancer-free.

Yes, I buried the lede

 

Special post written for the Montreal CIBC Run for the Cure community

When humans, like other animals, are faced with a threat, we have instinctual reactions: fight, flight, or freeze. These instincts are deeply embedded in our brains, and depending on the specific threat, the same person may get aggressive, run away, or stand there like a deer in the headlights. So, if the threat is a mosquito, for instance, we aggressively swat it (and perhaps feel a thrill of conquest when we crush it between our palms). If the threat is something bigger, like, say, a swarm of mosquitos, we retreat. And if we’re in some weird sci-fi movie from the 80’s, and we encounter a mosquito the size of a house, we probably freeze as our brains try to figure out WTF that thing is.

Porges’ polyvagal theory suggests that our responses are hierarchal, and our reactions, if we’re more or less stable, match the situation—single mosquito, we fight, swarm, we flee. The theory is based on an anatomical nerve system, the vagus, which connects relevant parts of our brain to almost every part of our body. In yoga and similar practices, we use breathwork to “calm the vagus nerve,” that is, we self-regulate, and try to control our responses. This approach is particularly important when dealing with trauma, which may trigger responses even when there is no “real” threat present.

At the bottom of Porges’ polyvagal response pyramid, the relaxed, happy, safe feelings are related to social engagement and connection—we are social animals, and thrive when we feel positively connected to others. Community, and feeling like we’re part of one, is a fundamental aspect of feeling safe.

In my research in education, I have spent a lot of time and words on the concept of the community of practice—in a nutshell, this means that more often than not, the professional development resource we turn to is each other. As a teacher, I have turned to my colleagues for help with every aspect of the job, and have in turn provided support to them; after all, who better to help you figure out classroom management, assessment strategies, deadline policies, or that tricky projector hookup in A111 than someone who has been there, literally, before you?

Continue reading “Connected through Cancer” →

Based on a manual exam at this morning’s pre-chemo check-in, my oncologist says that the tumour is practically gone. Aurora Flewwelling-Skup says I’m an overachiever and this is one instance in which I am very happy to be crushing it.

In anticipation of questions:

• This does not change the treatment plan; it does validate the plan.
• I have one more round of chemo in this phase, later this week.
• Phase II begins on June 1st; in Phase II, I get weekly treatments for 12 weeks.
  • Phase I has been described to me by several members of the medical team as the hardest, so I am looking forward to Phase II. My immune system is likely to be stronger, so I can be a little less paranoid about being near people.
• This does not affect the surgical plan; the idea with the neoadjuvant approach (chemo first, then surgery) is to have a clear idea of how I have responded to the chemotherapy before undergoing surgery, so that the surgery can be more precise and ultimately successful.