Week 7 - It's going to look like a baseball

Well, the ugly face video elicited a "we'll talk about options when you come in again." Sounded good to me.

So, before my appointment this week I went to Victoria Secret and bought 3 bras, checked the return policy, told them my doctor wanted me to bring them in to try them on. They were fine with that. Return policy is 90 days.

Last weekend I struggled with wearing what I wanted to wear without having to put a bra on and forms and stuff. I really do want to go without a bra when I want. I went over to the elderly neighbor lady's with some berries. She had a little difficulty looking at me after her first glance. I hadn't told her yet that I had had surgery. I was wearing a camisole sans bra and things just didn't line up.

So I planned on how I was going to deliver the news that I didn't want to just take care of the right breast, and I didn't just want to be bigger, but really what I wanted after all - decision #3: symmetry. And I really hoped to achieve that and look somewhat natural. I think that may be a challenge that you might not find when you are doing a bilateral reconstruction.

Wed. Appt.
Dr. C and I had a good chat. He says, "So have you been practicing?" when I started to discuss the distortion (as I like to call it contortion) issue. I said, "Yes, but, I'm having a hard time doing it now." "Here, push your hand against mine." Ok - it really didn't seem so bad after all, especially as we talked about the option he could use to alleviate that. He could separate the muscle from the skin tissue that had attached itself on the underside and put the implant above the muscle. That could mean that ripples would be more visible, but he felt that I had a fairly thick layer of skin and tissue and that wouldn't be a big deal. I think I can live with the movement that I have.

Next topic - Symmetry
"I know I've been indecisive about what I have wanted to do, but I've never been down this road before. I never gave breasts much thought, besides wearing a padded bra. What I think is more important than size is symmetry. I want to be able to wear a tank top, a camisole or whatever without being lop-sided and not have to wear a bra if I don't want to." The nurse was in the room part of the time. I told them the story of the neighbor lady not being able to look at me. We had talked previously about a breast lift and small implant for the left to help it sit higher like the new one will. So we talk about what can be done. "Well, I think we need to fill your expander up  to 400 cc. It will be like a baseball by the time we are through." Great, I love that image! "Then we'll do a lift and a 150 - 200 cc implant on the left." I have a favor to ask,"Can we make the right one droop just a little bit?" No. Can't do that. "I just don't like the way augmented breasts look, they look like headlights." Dr. C: "What do you mean?" Me: "They look so fake. I don't like that." Dr. C: "Well most women like that - perky breasts." Me: "Well, I guess if that's the worst case scenarios that's ok'."

Topic: Cohesive Gel Implants
Dr. C has is very passionate about the cohesive gel implants. These are newer silicone implants that do not leak, have been used in Europe for many years, yet the FDA hasn't approved them here. And there aren't many trials going on. He is very passionate about it - he would like to be able to provide a safer alternative for his patients. On Wed. I said, "I am almost as passionate as you about cohesive gel implants." Dr C. "You should start a jihad, and go to Washington. Let them hear your voice. Or no, Ghandi, that would be better, a peaceful protest.Go sit on the grounds." "Absolutely, I'm on it. Peaceful is best." I'm wondering if I could initiate a virtual protest regarding the slow process for approving cohesive gel implants. Does anyone have any ideas?

We go on to discuss surgical techniques for lifts. Dr. C: "Have you read anything about mastopexies on the internet?" Me: "Not that I can remember. Since last week I've stopped doing internet research!" Dr. C: "Well, I was going to suggest that you maybe stop using the internet." Too funny. Dr. is ordering me to stay away from the internet. No more breast research! But, there is this last approved search, and that is for the conventional mastopexy and the vertical incision mastopexy.

After I got 30 cc added and before he left the room "Do you have a bra to try on to see how things look?" "Yes, I do. Here this should be a good one." I put the bra on. "Yes, they are about the same size now." Little bit by little bit I will figure things out.

Wed evening after dinner internet search begins.
It's hard to find anything with the word conventional used and nothing that seems very substantial. I did find a video of Mr. Umar Khan displaying his surgical talent on youtube. OMG. I wonder what the point was. http://youtu.be/SwJplZjsS7s
 I don't think I really needed to see that. I found a good article on WebMD, but still didn't know what I was looking at. Thank God for WebMD, but I'm still not seeing anything that helps me out. I think I'm cured of using the internet, at least for breast-related topics.

So, back to the internet Saturday for more physician sanctioned research, although I think my prescription will run out soon. I found a good article on Wikipedia, which was kind of technical but very thorough. I supplemented with additional sites. There are many names for each procedure. And some photos. I'm not liking the photos so much.

I am finding that tighter sports bras and camisoles that provide more support are actually more comfortable most of the day than wearing something lightweight, less tight with a form in. I don't know if it would have made a difference in comfort earlier, and we'll never know. I actually wore one of my new mastectomy bras for a full day this past week. I wore a tight sports bra for a whole day. I'm developing! I think it's better even if they are snug that there isn't a whole lot of structure. I tried another mastectomy bra on this morning and decided against it.

Now's the time to get fit for life! I did start some exercises this week in addition to my walking. I really need to work on that. I'd like to lose min. of 5 lbs before next surgery and then just stay fit for the rest of my life. What a dream.

So, I think that I need to ask Dr C if I'm not allowed to get information from the internet where should I get it. Actually, I've read of a number of surgeons who either give this book or recommend this book to their patients who have mastectomies. The Breast Reconstruction Guidebook by Kathy Steligo. http://www.breastrecon.com/  I plan to order it and perhaps take it in to Dr. C after I have had a chance to read it. You can read parts of it from the site linked above. I put that link in resource links on the left as well. Dr. C has a very personal approach to  his patients. But I have to tell you, from the General Surgeon, to the hospital, and current treatment, I've had practically no printed educational material. Nothing from the General, the wrong post-op instructions from the hospital, and when I mentioned it all I got was incision care instructions. I had a fairly decent book put out by a silicone implant manufacturer given to me at Dr. Cs office, but there are many things that aren't in there. I realize that reconstruction of the breast isn't the only work that they do, but, I think somewhere in those provider contacts there should be more information available that one can have and hold and use to help make decisions with.

I am finding that I am not only a patient, I am an observer. I am analyzing what is happening, when, where and why.

Until the next update. Whenever that may be. M

Week 6 - Things are getting tight

So, I worked at home the rest of the week last week - glad I have the privilege to do that.

Discomfort changes with each fill - it's a different type each week. This week I had an additional 30 cc added - now at 240 cc. Talk about a tight pectoral muscle - almost feels like I am out of breath at times, but it has nothing to do with that. This week I worked at home Tuesday, Wednesday, and today. My breast doesn't look quite as ugly as a pug. I think we might be Shih Tzu this week after my fill. But here's what I'm really afraid of - check this video out.  http://www.breastcenter.com/procedures/distortion_procedure.php. I'm checking with my dr. to see what the risks of having an "ugly face" are for me. This is scaring the heck out of me!

I've done a bunch more research about reconstructive techniques/technology. Amazing what is out there using just your own body tissues. Perhaps the surgical procedures that use tissue but not muscle will become standard someday, but they are very time consuming and require reattaching blood vessels while looking through a microscope. Needless to say, not many surgeons are doing it. However, not relevant for me, but could be for women who aren't candidates for implants.

Dr. C is willing to entertain all sorts of questions and appears not to be rushed. We had a discussion about size, and he was concerned that he hadn't put a large enough expander in, but he thought he could overfill it. I left thinking, "Hmm, what were the chain of events anyway? What were my initial expectations?" Well of course, I just wanted the darned alien out as soon as possible. I didn't care about boosting size. So, he used the appropriate expander. We all have to take responsibility for our own decisions, don't we? So when did I start caring about getting an up-size cup-size? Well, at my first post-op visit we briefly discussed the droop of the left breast and how we could make it more symmetrical with the right when we get that one finished. That was it! Twas the months before surgery and visions of bountiful breasts and lovely cleavage danced through my head. I kind of forgot that our main goal was to create symmetry. So I needed a little reality check this week. I don't think I have that yet. Well, now I'm just confused about what I want. My main aim is symmetry from side-to-side - the challenge is, if your left natural breast droops a bit, and your new man-made one looks like a headlight how to make them look symmetrical. We talked about a lift, but that would mean another visible scar. So then the other option is a small implant. I mean really, if you were looking at me and you saw my left breast pointed towards your belly button and my right one towards your chest, what would you think? You'd think I was a little strange, especially if you could see the Ugly Face too!

Asymmetry - Look up, Look down

Less asymmetry, but it looks like you're not tracking

Last week when I said, "I want a B cup", he looked a little puzzled and asked what I am now (on the left). "It's an A." I went home and researched cup to volume equivalencies and the best I could find, was that if you   fill a bag with some rice and place it in a bra, you can put more in, take some out until you fit in the bra of choice.  I measured out rice, about the size and depth of the tumor that was removed, put it in a ziploc bag and took it with me to Victoria Secret's this past weekend to insert into a bra when I tried it on - the gal really wanted to measure me and all. I said, "No, I just had a mastectomy, and I just want to try one on." She was gracious and gave me her name and took mine. She didn't know I had a bag of rice with me though! I think I need about 90 cc to be a B.

I found out with this week's visit that they have some sort of bead packs or something you can place in your bra, but you have to bring a bra in that is the size that you want to be. So maybe I just need to give in and go pick up a couple of bras and check the return policy so I can figure out who I want to be when I grow up. Here's something to amuse you.

Bra with rice bag - so this is a mastectomy bra and it's not exactly what I want to wear when I grow up, so it won't do.

That's about 90 cc of rice.

Not getting to walk as much, but still walking. I even did a little mall walking when I went to VS because it was raining out and the last day of competition. People have been asking me if I have lost weight -"No - that's my next project". "Your pants are saggy in the butt." Well, I'll be darned. I didn't think I had a flat butt, but it appears to be so. I think it just moved to my thighs. Lordy! So, now that the walking competition is over, I need to work on the other body parts with weights.

Last week I was working on my visualization skills - trying to develop a positive image of the new breast I can look forward to. I'm envisioning beautiful clouds, with lovely breasts, just like you see in this photo.

Highway to heavenly breasts

Not so bad for starters is it?

It's been about 6 weeks since surgery, about 10 weeks from discovery. I don't think I got much research done prior to surgery, but have spent a lot of time since looking for resources, not just for me, but anyone who might need them even more than I. I'm trying to think of ways that I can make finding reliable information quicker and easier, and when one should start thinking about different options. We'll see. Of course for it to be anything more than therapeutic for me, I'd need to find a way to get it out there. Not saying I'm going to do it, just thinking about it.

I'm adding a couple of resources to the left - look for Susan G Komen and a link to Young Survivor Coalition - probably the best resources anyone could start with, in particular for women with breast cancer.

I hear that it is dinner time. Later!

Week 5 Update

You are probably going to get updates until I stop having weekly dr. appointments. Hope you can live with that.

I went back to work full time this week. Aahh. Retirement must be kind of nice, or part-time employment. I just haven't come up with any creative ideas to make that happen for many years to come. I keep telling myself I am lucky to have a job.

Well, we didn't do a fill last week due to some skin issues near the tightest spot in the breast and incision. All was clear this week, so 30 more cc went into the expander. Thank goodness I worked from home today and will tomorrow as well. I am not very comfortable. I probably have a couple more fills to go then we will wait a couple months before the next surgery.

I wore a well-worn bra yesterday that still fits with a form or whatever you want to call it. Thought it would be ok. All day is too long for any bra just yet - I had spasms by the end of the day. Since I was at work it wasn't like I could just take it off! So today I wore a bra for about 3 hours and off it came.

I  have been doing some stretching exercises and I think that has helped with both range of motion and stretching my pectoral muscle, which I think helps to make my chest less tight. The expander is only behind the pec (and skin), which if we review our anatomy, goes across the chest. Guess that's why I have been feeling the expander under my skin recently under my arm and higher up on my chest. The nurse said that is normal.

Did your mother ever tell you not to call others names because it might make them think they were no good, stupid, ugly, whatever the appropriate term might be? Mine did. So I've been visualizing my breast as the "Ugly Pug" and I've been doing some self-talk about coming up with something kinder and more positive for this maimed body part. I mentioned that today - I guess I'm allowed to call myself any negative thing I want (Mom wouldn't encourage that), but if I want to change to a better image I could select different dogs for different stages, picking those with better facial features, as my breast improves its shape over time. I also realized that perhaps I am not thinking of my new breast as part of myself yet - it's another entity. Interesting concept - to me anyway. I'll probably have to adopt it eventually (the breast).

Can you help me with some photos or names of dogs that I might use to represent stages of redevelopment? Humorous is fun.

Stages of Development

I can't decide whether a Boston Terrier's nose represents my current condition or the suggested Shih Tzu. Perhaps that is next weeks style. Anyway, I guess you get the idea. And no, my breast is not hairy like a dog's face. We are talking about the amount of smashed inness of the nose in relationship to the shape of the breast not the hairiness of the creature!

My Aphrodite Reborn book came in the mail yesterday and I really like it. It is a photo book with post reconstruction photos and short stories a number of women who went through mastectomy and reconstruction at least 10 years ago. Very well done. The photos make it more personal, and stories make it all more relevant and touching. I am impressed with the women who have either gone through bilateral mastectomies for prophylactic reasons or any surgery and treatment due to malignant cancers - their bravery and their beauty. Reading this book also reinforces for me that I need to visualize prettier and more positive images  than dogs I consider ugly. I'm working on it but I haven't come up with anything yet so I'm open to suggestions.

I'm out of here. Check in with you later!

What's new, or not ...

Well, we finished up our weekend at the beach - beautiful weather. We had some drizzle Sunday evening which didn't pose an issue for any of our indoor activities!

On one of my daily walks I saw some interesting seaweed colors. You might enjoy them too.

I don't think I've ever seen anything like this before. I'm hoping none of you will tell me it's a piece of trash. I would hate for my bubble to be broken!

I liked this one too.

Every walk I took was different - tide was in or out. Different rocks, pieces of wood, people and activities, you name it. I loved watching the dogs running in and out of the water. They just love it.

And I created a new ring. I need to perfect the design a little, and may add some variations to it as well over time.

Wire ring

I'm doing fine, thank you. I continue to have sensitivity and muscle tension, which I'm sure I will have for some time. Do any of you know what it is like to have your breast in a vise? That's kind of how it feels most waking hours. And if you forget or can't find your breast pillow for night time, you may feel it then too. That breast pillow is one of my best friends! It doesn't look like what your are thinking of - it's just a small pillow about 6"x12" in size. Just big enough to lift your arm off of your side and relieve some of the pressure. You might even use it when you are driving or riding in the car. I feel like a kid with my "blanky".

Wednesday was my follow-up with my plastic surgeon. In the morning before I left home, I was checking my incision out (with my 10x magnification mirror) and that little spot that wasn't as well approximated as the rest looked really big and seemed to have extended further. Well needless to say, it really wasn't as big as it looked in that mirror, but yet it looked different than the last time I checked. Mhmmm. Wonder if we get a fill-up today. The nurse thought the doctor should check first, so before we added more fluid Dr. C checked it out and decided we would let it go as is for another week. That was the point in the incision where it was the most stretched/stressed earlier. No rush.

The breast, with the expander in it is quite firm. I hoped that wouldn't be the new state of affairs, so asked if that would be how it always will be. I am reassured, that no, once we put the implant in, it won't be that firm. That's good.

Dr. C asked if I had been doing any stretching or exercises and I said "No, when I mentioned that I had started stretching last week you gave me the hairy eyeball." Well, he promised no hairy eyeball this week. I got clearance to do pretty much anything, but he will help me out by restricting mowing for a couple more weeks at least. Glad SO isn't reading my blog!! So, I'm ready for stretching it out, lifting, bicycling, and getting my mildly restricted range of motion back. And, back to work, of course! Progress is being made.

 I find it interesting to note the various emotional and logical responses I have to having had one breast removed and being in a transitional state. Some of you may already know about that. I am kind of feeling like "You remove a woman's breast, you don't know what she will do next." It's almost a call to show my femininity, or my daring. What else might I lose that has this kind of impact?  I haven't said it to the doctor yet, but I have given my right breast a title of "Ugly Pug". For those of you who love pugs, please don't be hurt, I just don't see the cuteness or beauty in them, or my breast.

After my appointment I went to Just Like a Woman to pick out my first new "in transition" bras. Great shop with personalized service and fitting. I walked away with two new bras, some bra stuffers, and a pair of dimmers. Quite an exciting event - I haven't worn a bra in weeks. The strange thing was that none of the bras from one maker to the next are sized like the other either in chest size or cup size. You really do need to try them on. They had a copy of "Reconstructing Aphrodite" in the dressing room. I only got to glance through it but think I will look for it. It's almost an art book you would put on your coffee table! Some of you, but maybe not all! http://www.reconstructingaphrodite.com/index.html

I've talked about getting caught up on my preventive health things before. Today I went to my primary care doctor for a physical - something I haven't done in several years. He really liked my tumor photo - just had to show him. When he asked if I had had my colonoscopy yet (50 years+ you know) I said, "Not yet. My philosophy is that I'm 50 until I am 60... (he's giving me a look, maybe a hairy eyeball) I add, "until recently. I will schedule one this year. Who do you recommend?" For the most part that's all I have left to do unless my labs come back with some issues, though he'd like for me to get a scan for osteoporosis. We'll see if that happens this year - probably not covered by insurance. I'll check with a few people at work to see if they know what happens with that.

I asked him how he selected Dr. I (general surgeon) for my referral. He had assisted him in surgery and had referred patients to him over the years because of his skill and calm manner. We don't know what we will do when Dr. I retires before our health care needs are over. I asked if he knew of Dr. C - "Yes, he is a top plastic surgeon and well known in the area." Good to know.

It's interesting to see how federal/Medicare mandates impact practice these days. Different questions, forms, and papers to take home with you. I need to look at those some more. I have my doubts that sending information like that will change health care behavior or motivation. And, guess what - may be totally unrelated. No female rectal exam - at least in my docs practice. So, if you haven't had your physical and that was the only thing holding you back, do consider it!

Clothes didn't have to come off for this exam. Honestly, I was so hoping I'd have to get undressed, because my new big girl bra was really bothering me and I couldn't wait to take it off. They do say to break them in slowly a few hours at a time. Might not be up to wearing bras to work next week for full days, but I have an alternate plan. Yes I do. A dimmer on one side, a padding form on the other in a cami with a light shelf bra in it and I am set.

So now, as you can see, I am anticipating the normal things that life is made of: yard work, bicycling, bra wearing, fill-ups on my expander until I am right-sized or full up, hiking, working to bring in the dough that pays for the house that Jack built, and all of the wonderful things we do in everyday life.

Anyhow, just my thoughts for the week. Have a good one, and again, thanks for being there.

Several things, including activities for healing...

Follow-up visit with General Surgeon

On Thursday I had my last visit with Dr. I, until after my implant is in. He had a Resident with him and  explained that he would be going into more detail with her for her learning experience. I'm all for it - except for 1 hospital that I ever worked in, all have been teaching hospitals. Everybody needs learning opportunities. He talked a bit about presenting my case to the tumor board. The board agreed, of course, that the treatment was appropriate based on tumor size and type. They were fascinated by the size and growth of the nasty alien thing. Other than that, tissue, incision, sensation even in its abnormal-to-me condition, are all looking good and as hoped for.  

I wonder about physician patient relationships. One builds a relationship relatively quickly out of necessity, establishing some sort of bond. We need to be able to trust for treatment and healing. To me, lack of trust would not enhance that process. The relationship, if we are fortunate, is a short-term one and patients go on to live their lives, physicians to see and help many more patients. If we are fortunate, patients need few of those short-term relationships. I wonder how physicians are able to build that relationship so quickly and so briefly with so many people. It may be taxing, or perhaps it is just a part of what they do every day. Mhmmm. 

Activities for healing

Well... so the best part of my entry today. I'm at the beach. The weather is fantastic. Yesterday morning I sat on a window seat facing the ocean, ocean sounds in the background to work for 4 hrs. Painful, right? I've had some good beach walks. The stars last night were fantastic. This morning when I got up I looked out the window to see how low the tide was. OMG - I need to be out on the beach now! It was way out there. I wanted to go down around the Cape to see what I could see. As I walked I heard a woman comment that the tide was at its lowest so far this year.

Bed head - why is Ocean Air bed head so much worse than Desert Camp bed head, or Valley Air bed head? I try to dampen the hair do down, get my clothes on, grab the essentials of water, rock bag, camera and binoculars. Don't forget money, because I have a feeling that I'll be getting a coffee and breakfast sandwich while I am out. The mirror is a little high for me, so I'm probably not seeing everything I need to see before I head out. Ok for me, but I feel sorry for those who are looking at me! But I need to get out there while the tide is so far out so I can get around the point at the north end of town. No time to waste.

Imagine this - listen to the ocean all day and night long; hot tub any time of the day you wish while looking at the ocean; listen to bird sounds; enjoy seafood meals. My gift from dear friends to help me recuperate. I think it's helping!

I want to share a few pictures from yesterday and today.

18 arm purple starfish

Cape Meares Light House

Catching the wind and waves

Tide is way out

Our view

Beach flotsam

Current favorite colors - charcoal gray and lime green

Star fish everywhere

Our friends, who are loaning us their beach condo for the weekend, purchased an Encaustic work of art last weekend while attending an event in Cannon Beach. I had looked up the artist and his work on the web, so I can totally envision the star fish photo as a painting. Anyone want to do that for the fun of it? Here's the link to Christopher Gerber's website. Good stuff.

Not to forget today's Farmer's Market in Tillamook! Yet again, we found some fresh Hood strawberries, Bing cherries, asparagus. We stopped and picked up a crab. You want to join us for dinner?

It's all good for healing - relaxing, being active, seeing art and nature and art in nature, and everyday stuff. I'm on my way.