Breast Cancer

Recess

I hadn’t planned on joining Congress in taking a recess during August, but apparently, I, too, needed a break from blogging. Ironically, though, the past month has been anything but uneventful.

The Boobs (or “Foobs,” as some of us in the breast cancer community call them): The first week after my reconstructive surgery was rougher than I had previously indicated. See, the surgery had ended, but I surprisingly woke up while I was still in the Operating Room. That’s not supposed to happen under general anesthesia! I began screaming, “It’s too soon! It’s too soon!” As I was moved onto the gurney and wheeled into the Recovery Room, I felt very dizzy and got sick. Those symptoms continued for the next five days.

One week later, I noticed that my left breast looked sunburned. It was pink in color, swollen, slightly painful and warm to the touch. I wasn’t sure what was going on so I paged my doctor on the weekend. She recommended that I meet her at her office on a Sunday. (Yes, it helps to have doctors like this who go above and beyond!)

The thought was that I had developed an odd reaction or mild infection. She put me on more antibiotics. In total, I’ve been on antibiotics for all but five days out of a two-month period!

Two weeks later, the “sunburn” is slightly better. The left side is still swollen, though, and the surgeon thinks that my skin is having an abnormal reaction to everything that has transpired. The hope is that it will improve naturally over the next month or two.

Teaching: To say that I love teaching at American University would be an understatement! Nevertheless, it might not have been the best move to agree to teach a seven-week online class during my season of surgeries! (I'm sure I should have rested and relaxed a lot more than I did.) The summer class required me to be online so much that I just didn’t have the energy to be writing outside of that.

The Man: If I’ve had free time over the past month, I’ve spent it with my loved ones. The Man is definitely at the top of that list! Since surgery, he’s handled every ride, every dog walk, every grocery store run and every doctor’s appointment. I’m not sure what I’ve done to deserve someone as wonderful and caring as him in my life, but I feel grateful.

I hope that all of you had a relaxing and fun summer! How did you spend your holiday weekend?
 

I Didn’t Have a Boob Job!

“I thought that you were done with surgery, Stef. What are you going in for this time?” several friends inquire.

“This is the second stage of reconstruction,” I reply, noticing my friends’ confusion. “They take the temporary expanders out and put the permanent implants in.”

Knowing looks follow, as my friends begin to register what the process entails. I quickly interject:

This isn’t like getting a boob job, though.

“It’s not?!?” they comment with surprise. I then exhale as they launch into a well-intentioned story or ask a question about elective breast surgery.

How is Breast Reconstruction Phase Two not like Breast Augmentation?

1. The Incision: During a boob job, the surgeon makes a tiny incision near the armpit, the areola or below the breast. In breast reconstruction, the surgeon needs to open up the old mastectomy incisions. If my breasts were globes, my scars resemble the equator. My incisions are thin, but they are the entire width of my breasts. (For those of you who would like to see a photo, the first image from David Jay’s Scar Project is a realistic depiction of what my breasts will look like once the stitches dissolve.)

Yes, scars will fade. Yes, I can use Vitamin E oil to expedite the process. But, my surgeon anticipates that I will need laser treatments next year to help reduce the appearance of the scars.

2. Nipples: Women with elective breast surgeries still have their nipples. I have none since they were removed during my mastectomy surgery. (Breast cancer can originate in the milk ducts.) My boobs are like those on a Barbie doll. I plan to get new nipples made from a skin graft as soon as I am able to in 2013.

3. Muscle, Tissue and Swelling: In a boob job, implants are placed over existing muscle and tissue. That’s why after a breast augmentation, a woman’s breasts are so high and pronounced. During a mastectomy, all breast tissue and muscle are removed. Since I don’t have any breast tissue or muscle, I’m not swollen. What I see when I take off my surgical bra is an accurate representation of the size of my breasts.

4. Excitement: Women who get breast augmentation are elated to show you their fabulous new tatas. They chose this elective surgery. They wanted their new breasts.

I had breast cancer. I decided to get mastectomies and reconstruction, after reviewing my options with my team of oncologists and surgeons. Prior to my diagnosis, I never thought about getting any cosmetic surgery on my breasts.

Am I cautiously optimistic that this is my last surgery for a year? Yes. Am I thankful that these surgeries have dramatically reduced my risk of getting breast cancer again? Of course. Are they large, symmetrical and perky? Yep! Do I view my breasts as "mine" anymore? No, not at all.

I viewed last week's surgery as a necessity. I needed to have the expanders replaced with permanent implants, and they were. I've jumped over the next hurdle. 

I felt angry and sad regarding my mastectomies and ambivalent about reconstruction. Nothing about this process has involved excitement, aside from the news that I'm cancer-free.

I’ve tried to be as open as I can throughout this process, and I’ll happily answer any questions that you might have. Just please don’t ask me about my boob job.

The Change

It happens to 50% of breast cancer patients under the age of 35 who require chemotherapy.

For those breast cancer patients who need chemo and are 35-40, the statistics go up to 80%.

If you are over 45, have breast cancer and receive chemotherapy, it’s almost guaranteed to happen to you!

“What are you talking about, City Girl?” you might be wondering.

The Big M. The Change. Menopause.

How does chemotherapy-induced menopause differ from traditional menopause? Dr. Melody Cobleigh of BreastCancer.org describes it as follows:

“Natural menopause is a fender bender, whereas medical or surgical menopause is like hitting a brick wall at sixty miles an hour.”

That analogy resonated with me. In October 2010, one month after I received my first round of chemotherapy, I began to hemorrhage. By November, I stopped bleeding entirely, and the hot flashes started. Night sweats, sleep problems, and irritability soon became part of my daily routine. And, then, there was the dryness down there. Yes…there!

Think about it. Back then, I was the 37-year-old sex blogger with an active dating life. Once menopause hit, I couldn’t get wet even when I was turned on. If I wasn’t a woman who prioritized sex during treatment, it would have been very easy to just forgo the act entirely. I had to consistently remind myself that this was important to me since my body wasn’t cooperating.

During chemo-induced menopause, traditional sex was painful at times, and I always needed a lot of lubrication. It took me much longer to reach orgasm. Cuddling for more than a few minutes would cause me to get such intense hot flashes that the entire bed would be wet from my perspiration. And, the lack of natural moisture made my pelvic muscles tighten up so much that I felt like I often had a UTI, even though I didn’t.

I didn’t write tons about this all during treatment because I needed to channel my energy in a positive direction. Medical menopause isn’t sexy. It's not easy to talk about. And, it made a tough time in my life even tougher.

Once I finished chemotherapy and stopped estrogen blockers, my menopause side effects subsided. I wasn’t surprised when my period returned in August 2011. However, when my cycle resumed, it was quarterly, not monthly. I wasn’t in full menopause anymore, but I wasn’t back to normal either. I called it, “The Pause.”

Something inside my body finally decided to press the “Play” button, though. I'm pausing no more. My 30-day cycle returned. Menopause is over, although the doctors believe that given my age and chemotherapy, my eggs are no longer viable. I'm hoping that the next time I experience menopause will just be in the words of Dr. Cobleigh, "a fender bender."

What are my tips for female breast cancer patients under the age of 45 who might have to worry about early menopause?

1. Talk to your doctor, nurse or case manager before you start treatment about the possibility of medical menopause. What should you watch out for? What's the protocol if you start hemorrhaging? Will you need to take an estrogen-blocking medication after chemo that could prolong or induce menopause?

2. Think about the long term before you deal with the day-to-day of treatment. Do you want to have biological children? If so, should you meet with a fertility specialist to discuss freezing your eggs before you begin chemotherapy? Err on the side of keeping all of your options open.

3. Be informed! Read as much as you can from reliable medical sources, check out nonprofits such as Fertile Action, and talk to survivors who have been through it before.

4. Make healthy choices for your body. Approximately ¾ of breast cancers feed on estrogen. Many toiletries, including lubricants and vaginal moisturizers, contain parabens, which weakly mimic the action of estrogen in a woman’s body. Select products that are paraben-free.

Did you know that chemotherapy could cause medical menopause? If you are a patient or survivor, what was your experience?

Wanting Your Old Life Back

I’ve written a lot about not feeling like myself since I began treatment for breast cancer. Deep down, I know that I’m more than the sum of my parts, but there are moments when that doesn’t provide solace.

At a recent charity event, an acquaintance complimented my short hair. Without missing a beat, I cringed and told her that I'm not a fan. She responded:

You should feel lucky that you’re alive!

I looked at her with a confused expression on my face and said:

I do. But why does my sadness at the after effects of chemo need to be mutually exclusive from my ability to count my blessings?

It’s not easy figuring out who you are after you’ve experienced a major life event such as being diagnosed with cancer. The rest of the world continues as normal, but your life can never go back to the way it was before. I felt that way after I started to go paralyzed in 1994, after my mom died in 1997, and when I was diagnosed with cancer in 2010.

What’s my advice for a breast cancer patient who just wants to go back to her old life? Check out my video for Breast Cancer Answers.

And, for those of you who are wondering, yes, there are still times when I need to remind myself to take my own advice! xoxo

Cups of Clarity

“I write as a way to communicate with friends from all stages of my life and receive support from others.”

Those words appeared on my site three months ago, and I was reminded of why I wrote them again this week.

I needed a cup – or two – of clarity, and I received that from you all. Thank you, dear readers and friends.

In response to my post about what size implants I should get during the second phase of my reconstruction, several of you asked me the following:

How did I feel about my old breasts?

Did I think that they were too big?

Why did I wear minimizers?

Did I have back problems?

Those questions are seemingly simple, but none of them had crossed my mind before I received your comments and emails.

If I had to speculate as to why I didn’t consider them, I’d attribute it to the reality of life as a female post-breast cancer. Seeing my reflection with short hair and sparse eyelashes still makes me cringe on a good day and tear up on a bad day. The chemotherapy drugs and steroids continue to work their way out of my system so my weight isn’t something I can easily control and my immune system resembles a child’s.

I feel so different about my appearance that I think I viewed selecting implants as a way to make myself feel even more different. Since I don’t smile back at my reflection, what does it matter if my breasts are smaller? Why shouldn’t I go into Victoria’s Secret for a bra like I did when I was in my early 20s? I’m not like the old me anymore so my boobs don’t need to be mine either, right?

Your questions made me think, though. I loved my old breasts. I didn’t think that they were too big; they were perfect! I wore minimizers in public since that looked best under clothes and conveyed a more professional image. I have a lot of neck and neurological issues, but I’ve never had back problems because of my chest size (knocking on wood).

I have the clarity I need for the next phase of reconstruction. I’ll talk with my internist and physical therapist this coming week about whether a certain size is preferred from their medical perspective. Assuming that there are no restrictions on that front, I’ll let the surgeon decide what looks best in the operating room. (She’s not ordering implants as large as I was before so I’ll be at least 50 CCs smaller.) I might not feel like myself now, but I don’t need to select implants to make myself feel even more different.

I’m at peace with that approach, and I thank you for your support and input. xoxo

Is Bigger Necessarily Better?

For the majority of my life, I never shared my bra size with other people. I loved my tits, but I went out of my way not to flaunt them in public. I wore minimizers so my boobs would look 1-1 ½” smaller than they were. I chose certain tops that were boob-friendly so that they weren’t on display. I loved my big tatas, but I held that enjoyment close to my chest (pun intended, of course).

Since I was diagnosed with breast cancer, though, I feel as though my boobs are part of the public domain. I’ve shared my story and bra size with mere acquaintances, and my comfort talking about what I’m going through motivated me to write this post.

When I met with the reconstructive surgeon before my double mastectomy, I told the doctor that I wanted to be a DD. I had been a 34 F/G for the past 15 years, and I had a dream of going into Victoria’s Secret and buying a bra that didn’t cost $60.

Each week as I would get expanded at the doctor’s office, she kept asking me if I wanted to go bigger. I just kept saying, “Make me a DD.”

What I didn’t realize at that time, though, was that one size of expanders or implants doesn't fit all. Think about it. Every woman is unique in terms of height, weight, torso length, back width and build. On a woman that’s 5’2”, a G cup would look disproportionate. On me, at 5’9”, it doesn’t. Likewise, a woman who is larger in build could have the weight of my breasts and be a smaller cup size.

My real breasts were 600 CCs, and at my last expansion, my surgeon expanded me to 500 CCs. Afterward, she saw me dressed and commented, “That size looks right. Now, I notice your breasts first.”

I went home after that expansion and tried on some of my old bras. The majority of my G cup bras and all of my F cup bras fit.

A part of me felt like my dream of buying a mass-produced bra or swimsuit was snatched away from me. What does a City Girl have to do to be a DD?

Those who have seen me since that last expansion have commented that I look like my old self. My expanders are big, but not out of proportion with my body, much like my big naturals.

Three weeks from today, my expanders will be replaced with my permanent implants. (And, no, this isn’t the same as a boob job surgery since I have no breast muscle or tissue and weaker skin. In addition, the implants are inserted via my old incisions across the middle of my breasts, not via some tiny incision by the armpit.)

My surgeon wants to go into the Operating Room with three options of 450 CCs, 500 CCs, and 550 CCs. There’s a chance that I could come out of surgery wearing all my old bras!

I posted on Facebook that there’s a fine line between “nice rack” and “when do you perform?” The majority of responses indicated that when in doubt, it's best to go bigger. Women who’ve had reconstruction or implants noted that silicone is less voluminous than the expanders. And, other friends thought I should trust the doctor since she is an award-winning perfectionist.

I realize that I need to make my own decision about my implant size. But, I feel as though you all have come on this journey with me and would love your input.

Do I put my foot down and tell the doctor that I don’t want to be as big as I am now, or do I trust that she is the expert? Comments encouraged!

The Man

“It continues to amaze me which men step up and which men don’t, when their significant others are battling breast cancer,” my reconstructive surgeon said.

Your doctor can tell you how to best equip yourself to fight the disease or prevent a recurrence, but there’s no guide for how to make your partnership work in the midst of a health crisis. Some relationships flourish, and some flounder. You might think that you know what commitment entails or what it means to truly be there during the toughest of times, but it’s all speculation until you’re in that situation.

I had assumed that my most recent relationship would end around the time of my double mastectomy in late April. The Man and I had only been together for two-and-a-half months, after all. It was unrealistic for me to expect that he would be there for me during my surgery and recuperation.

Thankfully, I was wrong. So very wrong.

I found a man who isn’t just around when times are difficult, but a man who is present, helpful and loving. He takes initiative, and he tells me how proud I make him. He reminds me that being a survivor is sexy and that I’m strong.

I’ve been far more private about this relationship than I have with any other relationship. Some of it stems from how my career and brand have changed over the past three years. Another contributing factor is that I no longer seek volatile partners in intense relationships with every detail to later be shared and dissected online. Life has thrown me enough drama. I look for stability now in my personal and professional life, and I want to hold it close. And, finally, I’m involved with a humble man who is very private and views our time together as sacred. I respect that and would never do or post anything that would disappoint him.

With that said, I appreciate that many friends are readers, and quite a few readers have become friends. Given how many of you have prayed for my health and rooted for my happiness, I feel comfortable sharing this with you all —

There are those who leave when the going gets tough.

There are those who think that just showing up is enough.

And, then, there are those few who innately know what to say and do to make a situation better. There are those select people who value intimacy far more than they value sex and who take the time to communicate and build a solid foundation. These are the people who stick around and give of themselves unconditionally when others would walk out.

Thank you, mi amor, for being that rare man.

My 2nd Cancer-versary

June 22, 2010

My telephone vibrated in my lap. I asked my hairdresser if she could turn off the blow dryer. As I answered the call, I knew, even before the breast radiologist told me. Six previous biopsies had been benign (non-cancerous), but I had a feeling that I wouldn’t be so lucky with biopsies numbers seven and eight. When my doctor finally said the words, “breast cancer,” it felt surreal. I leaned up against the wall in the back of the salon and exhaled, as I shed a few tears.

In October, after my first round of chemotherapy, I had described my diagnosis and treatment as “a blip.” My cancer was caught early. I never doubted that I would survive. I would go through treatment, beat this horrible disease and move on.

Oh, to be so blissfully ignorant now!

There will come a day when I don’t think about cancer and what it has taken from me – directly and indirectly. But, for now, that seems far into the future.

On my second cancer-versary, I find myself rather reflective. I have so many reasons for which to be thankful! Most importantly, this was caught early, and I am in remission. My diagnosis has also strengthened old bonds and led to new relationships and opportunities. But, I’m not the same person I was two years ago. As much as I love who I am now and how my life has evolved, that doesn’t mean that I don’t grieve the old me on occasion.

Last night, I went online to look at the photo album from the night that I was diagnosed. I surprisingly found a photograph that I didn't know existed. It's not the best shot, but I remember vividly where my friend and I were standing in the bar, what we said, and our body language. That was the first time I told someone in person that I had cancer.

  

With K Street Kate

With Rania Jaziri of Jordin's Paradise, June 22, 2010

I miss the City Girl that I see in this photo.

For those of you who have followed my journey and offered support online and off, thank you from the bottom of my heart.

Please make sure that you have an annual appointment with a doctor and know how to conduct a self-breast or testicle exam. If you're a sexually-active female, visit a gynecologist and get a pap smear every year. If you’re female and at least 40 years of age (35, if you have a family history), schedule your mammogram annually. If you find or feel anything off with your body, trust your instincts and call your doctor. If you’re an adult and don’t have a primary care physician, get one!

There is so much in life that we can’t control. Staying on top of our health is something we do have control over.

With gentle hugs, much appreciation and best wishes for many decades ahead for all of us, Stef

Mastectomy and Reconstruction Q&A

I’ve received quite a few questions from friends related to my double mastectomy and delayed reconstruction (also known as the expansion process). Since clear information for non-patients is surprisingly lacking in this arena, I thought I’d do my part to remedy that.

1. Since your surgery was in April, you’re feeling stronger with each day, right?

Unfortunately, no. I get expansions every Thursday. I need to go home from the doctor afterward and take it very easy. I’m still in a lot of pain when I wake up on Friday through Saturday. By Sunday, the pain starts to gradually abate a little each day until the next expansion starts. I haven’t yet had a day without limitations or pain.

2. What does expansion entail?

My reconstructive surgeon placed mounds under my skin after the mastectomy. These mounds are called “expanders.” Most women require expanders after mastectomies since they have had radiation, lumpectomies and/or chemotherapy. (All of those compromise the viability of the skin, thereby increasing the risk of infection after the mastectomy surgery.)

During the expansion process, the doctor numbs the area where the nipple used to be and then injects saline into a port under the skin. The breast increases in size before your eyes. Depending on the woman, expansion can last for a few weeks or months.

The fact that expansion is very painful doesn’t receive a lot of attention. Some women use a numbing cream before the procedure. Others take ibuprofen or pain medicine before and after.

3. Are you done with expansion yet?

Right now, I have 400CCs of saline in my breasts. On my frame, that comes out to a DD cup. My old breasts weighed 600CCs. My doctor believes that I should be 500CCs. That’s bigger than I wanted to go, but I appreciate her concern for the aesthetics. (My skin would be a little saggy if I didn’t go bigger.)

Fingers crossed, I’m hoping that today is my last expansion.

4. How do your breasts look?

There wasn’t any bruising after the first week, which is amazing. There are thin scars across the middle of both breasts. Some of the areola on the right breast was spared, but the left breast has no areola. My nipples were taken since breast cancer can start in the milk ducts. I will have surgery next year to restore the nipples, but for the time being, I have boobs that look like a Barbie doll.

5. You said your mastectomy wasn’t that painful. My friend had a horrible time with the surgery. Do you have a high pain tolerance?

Mastectomies aren’t a one-size-fits-all surgery! Depending on how scarred or burned the skin of a woman’s breast is, she might require skin and tissue to be taken from her back or abdomen to rebuild her breast. That makes the surgery and recovery much more complicated.

I have been told that I have a high pain tolerance, but I think it’s wrong to compare one person’s experience to another. We all hopefully do the best we can with what we have to deal with. Taking pain medicine or talking to your doctor about pain management shouldn’t be viewed negatively.

6. Are you doing more this month than last?

Yes, thankfully, but it’s all relative. I’m so happy to be able to walk a lot like I used to. (I'm not walking as quickly and I need to be holding my arm over my breasts for support, but I’m okay with that.) I did participate in the Komen 5K two weeks ago, and I was proud to walk with my survivor sisters.

My upper body is very weak, though, and I’m in physical therapy. I have trouble raising my arms over my head so I can’t wash my own hair. I don’t have the strength to walk my dog or drive yet. And, it’s still tough to lift more than a couple of pounds or reach out to the side. I’ll get there, though.

A light touch against my breast is very painful. While dining with friends, someone accidentally bopped into my arm in a way that it lightly hit my right breast. I instantly had tears in my eyes and was in the bathroom getting sick within two minutes. (And, for what it’s worth, throwing up makes my breasts hurt more, as does sneezing.)

7. What’s next?

I will complete the expansion this month. I’ll continue with physical therapy to improve my strength and mobility through July. And, then, on July 31st, the surgeon will reopen the incisions on my breasts to remove the expanders and put in the real implants. There are many things that this process is, but short isn’t among them!

Did you learn anything new?

Have you or a loved one gone through the expansion process?