Yesterday I began feeling better. Still had the appetite of a sabertooth tiger, but had more energy, less of a headache, and stopped feeling feverish (but not actually feverish). Saw and heard from some very dear old friends, which was wonderful.
Acupuncture last night was pretty intense. I started taking Cymbalta because there is a June 2014 study that suggests it may have a protective effect against peripheral neuropathy, rather than just masking the pain. The acupuncture actually kind of made my nerves hurt, which it never has before. Like feeling the underlying peripheral neuropathy emerging from a drug veiled fog.
I wonder whether the Cymbalta is doing more masking than I thought. I went back and forth on whether to take it at all. I don't take ibuprofen before I work out; I want to know if I am doing something injurious. I would rather not take any drugs, given a choice. There are other drugs they can give you that just mask the neuropathy pain, but they haven't been shown to have any protective effect. The protective effect was really why I decided to take it at all. It is more commonly prescribed for depression. Oh well. I am on it as of 9/15. My onc said it would take a few weeks to build up the effects of the medicine, so maybe it just isn't at full strength yet. In less than a month, I will have my last round of the horrible cocktail, so I only need it for a little while longer!
I am already thinking about how to get myself weaned off all these drugs and figure out how to get my endocrinology and metabolism repaired. It's an ongoing research project. I certainly don't want to go back to the chemistry I had before, because whatever mix of lifestyle, environment, and natural body chemistry I had got me cancer. I would be foolish to think that following the same formula after treatment would result in anything different than a cancer recurrence. The recipe has to change, but I don't know enough yet to feel like I will be different enough. If you know any endocrinologists with a cancer prevention/antirecurrence focus, let me know!
Today turned into quite the adventure. I had my plastic surgeon consult for reconstruction options. On my way driving there, some guy came into my lane. I swerved to avoid him and clipped the curb on a curve. Two flat tires and a bent wheel. I was able to pull on to a side street right away and assess the damage. It happened so fast I didn't even have time to honk. He didn't stop. Luckily, I was within eyesight of a gas station with a service garage. I walked there and they said I could drive it in slowly. $600 and a day later, it will be fixed. A random stranger drove me to my doctor appointment. I was only 10 minutes late, but by the time I got all my paperwork filled out, they were having to squeeze me in the schedule a bit.
The plastic surgeon was brilliant and personable. I didn't realize that normally she is not involved in a simple lumpectomy. She kind of was like, why are you here, but in the nicest way possible. We talked about reconstruction anyway.
Sometimes, during a lumpectomy, surgeons will move or rearrange tissue to achieve a good cosmetic result right then. The benefit is that you are not fighting any swelling or dealing with tightened skin from radiation, and you know exactly how much tissue came out so it is easy to assess how much should be replaced. Sounds lovely, right? Problem is that the pathology results, which take several days if done the best way, will not be known while you are on the operating table, and the mishmash of breast tissue afterwards means that instead of a slightly bigger lumpectomy as a second surgery, your only option is then a mastectomy. So no, we will not be doing that. Any reconstruction, if required, will be done as a second surgery. Unfortunately, if required, it would need to be much later. A year after radiation ends.
Radiation can result in shrinkage of the irradiated breast. The plastic surgeon said that in her experience, the larger the cavity of the lumpectomy, the more shrinking. Very fatty tissue can shrink more too. In addition, the tissue tends to pull in the direction of the cavity, but the degree cannot be predicted. Based on where mine is and the anticipated size, I might not have very much to deal with. And since I am slightly larger on that side, there is a possibility I could end up more even after this. I will take that with no complaints.
If the shrinkage were more significant, the way would achieve symmetry is not through fat grafting of that breast, rather through a reduction (lollipop lift or anchor, depending on how big) of the other healthy breast. Not awesome, but I have options. Radiation tends to freeze the breast in time too. As natural aging causes the healthy breast to grow/sag over time, the reduction and lift of the healthy breast would be my option at that time.
Radiation tends to be really great for evening out the scar, so I should not have to worry about that, unless I have a second surgery on that breast.
In the event that the resection or shrinking causes the nipple placement to go all weird, they also have ways to fix that, basically different ways of cutting the nipple out and rearranging it. The irradiated skin is much tighter and difficult to work with, but it can be done. Every surgery leaves a scar, but if I want it, I can deal.
I did mention Brava and the Miami Breast Center. She said he was the best at that, and others had trouble recreating his work. Because it would require a lot of fat though, she thought it might take a lot longer and not be as satisfactory as I wanted. Some portion of all fat grafts die, and the dead fat cells can calcify which can be perceived as a lump. Terrifying false positive potential there. Not interested.
In the event that I have positive margins (meaning, cancer is microscopically present on the edge of what the surgeon takes out), then I go back to surgery again. The question there will be bigger lumpectomy or mastectomy. Ugghh. Cross that bridge if it comes. If cancer recurs, it most likely will be in the same spot, but you can only get radiation in the same spot once (w very rare exceptions), so only a mastectomy would be an option then. Hope that bridge NEVER comes.
In all, my plastic surgeon said that maybe why my onco surgeon sent me is just in case we have to go back. Generally, it is easier to see what to do when you have seen the original. She will be in the next OR, and she said she could come over and check things out and that she would talk to my oncology surgeon about the game plan for me. It may also depend on post chemo imaging, which if are not offered I think I will insist on.
After the doctor appointment wrapped, I walked what should have been 0.8 mi to metro. People volunteered to drive me and help, but I thought I would get there faster by walking. My cell phone and blackberry died on the way there. I made a wrong turn and walked a half mile out of the way before I figured it out and turned around. I managed to get to work, finally, around 2:45pm. Metro home was easy, except for the blister on my foot!
Quite the day, but I was calm and I handled it. I am really feeling good about the game plan. Still a bit concerned about what is going on with the tumor right now, but at least the plan is going to be great!
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