I Didn’t Expect THAT: Breast Changes

Or more accurately “Breast Changes, Lack Thereof.”

This one threw me for a loop. Prior to my lumpectomy, I scoured the internet for ideas of what partial breast removal looked like. In a word, disfigurement. Certainly, having half a breast was preferable to having no breast or dying from breast cancer, but I wondered how I would deal with losing a secondary sex characteristic that society uses as an indication of female-ness. My breasts had nursed two bouncing babies into toddlerhood and cancer was going to take one of them (breasts, not babies!). That kept me up at night.

Scars
Top scar: sentinel lymph node dissection; bottom scar: lumpectomy. Teeny!

After dying a thousand deaths, I found that my reality was not nearly as frightening. My lump was small and sitting at about 2 o’clock on my left breast. That put it dangerously close to my axillary (armpit) lymph nodes, which could enable the cancer to spread faster, but also in a place where tissue removal would be less noticeable. Three sentinel lymph nodes were removed from my armpit — they were found to be unaffected. My surgeon was able to get “clear margins” (no cancer cells were seen on the edge of the tissue that was removed) on the cancerous lump, and if not for the scars, there was little indication that I’d had surgery.

Scar_arm-down
View of my lumpectomy scar, arm down.

That blew my mind. With small breasts, I didn’t think I could spare the tissue. I was contemplating a prosthesis, and concerned that the size of the excision might tempt me to go with reconstructive surgery…but none of that was necessary. Even my surgeon was surprised. I told her it was because she was an excellent surgeon, but she wouldn’t accept the compliment. According to her, I was just very lucky.

After radiation treatment, that breast tightened up and even gained a bit of size. All at no extra cost.

So, whenever I do a gratitude meditation and count my blessings, I reflect upon this. There are so many things that could have been worse, and I had gotten lost in the terror of it all. But in the end, it was okay.

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Note: I wanted to show how similar both breasts looked, but then there’s all this potential for getting flagged as inappropriate, so you’ll need to be content with “side boob” photos and just take my word for it.

I Didn’t Expect THAT: Chemo Port

When you’re told that you have cancer and will need the full complement of treatments, you focus on the concepts of surgery, chemotherapy and radiation. Chemo, for example, can be frightening to think about because of purported its side effects, so you gloss over the details. But when you get down to a practical level and start learning about exactly how the infusions will take place…

I knew I needed chemo. I assumed that it would be administered intravenously, as in, into an arm vein with the bag o’ drugs hanging from the IV pole. Ahhh, but the drugs are caustic and would cause damage to a smaller vein, so to avoid that, they go directly into a major blood vessel to allow for quicker mixing with blood, faster circulation through your body and much less discomfort. This is done through a port.

Let me be clear: a chemo port is a revolutionary device that has made administration of chemo drugs far easier on the patient. Not having the port would be absolutely miserable and likely necessitate breaks in treatment as the patient recovered.

Port_in_a_box
This little marvel makes chemo much easier. The dark purple circle is a soft membrane into which the needle is inserted (through the skin). The tube delivers the meds straight into a major vessel. Easy peasy!

However, it wasn’t until we were talking about setting up a port implantation appointment that I began to grasp what was actually going to happen: a small disk would be implanted onto my chest wall, just under the skin, from which a thin flexible tube would run up and over my clavicle and then down into the blood vessel (probably the superior vena cava, but I didn’t ask). Once I started infusions, the needle from the bag containing the drugs would be inserted through my skin, through a membrane on the port, and that was it for the needle prick. Simple and relatively painless.

But about that port. To me, “port placement”, as the implantation procedure was called, was surgery. And I wasn’t great at handling surgery. Usually I like a lot of info to prep me for what’s coming, but I couldn’t even handle watching a video of a placement procedure.

Port_Placed
After port placement. I was acutely aware of a foreign body poking out of me. Alien, anyone?

I don’t have a lot of fat on my chest. There was nothing to nestle the port down into, and as a result, after implantation my skin was stretched tight. I could see the lump in my chest and I could see the tube as it ran up from the lump, over the clavicle. Turning my head pulled the skin — ow! I avoided looking at it, let alone touching it. All I could think was that I had an entire year of this.

Eventually the skin stretched to accommodate the port, but because it stuck out like a little knob, I worried about twacking it. When I hit it with a dumbbell during a workout, I cried. Seatbelts were a constant concern; I was afraid that the port would get dislodged and injure me in a car accident. Hugs hurt and I instinctively turned that side away from people. And of course, in the event of a huge catastrophe that resulted in the collapse of society and all modern services including port removal procedures, I might be stuck with that thing on my chest for the rest of my pathetic little life.

Eventually, the day came when I finished my last infusion and my oncologist gave the go-ahead for port removal. That thing was out within a week. Removal was simpler than implantation, done under local anesthesia without the need for fasting, and even all the tugging to get it loose didn’t bother me. I was so happy to have it out.

But I’d carried it inside me longer than I had carried either of my children, so I asked to take the port home. While I had hated it inside me, I was so grateful for what it had done. I mean, I couldn’t just let them throw it out! It was handed to me in a bright pink box designed for dentures (apparently, keeping your port isn’t popular enough for the creation of “used port” containers) and now sits on my desk. I prefer it there rather than in my chest.

 

 

The Problem With Pink

The breast cancer awareness movement has done a good job of bringing cancer awareness to the forefront. Especially in October, which is Breast Cancer Awareness Month, it’s hard to see pink without thinking of breast cancer. This is particularly true for someone who has gone through cancer treatment, but I expect that many who haven’t strongly equate the color with the cancer too.

Certainly, it doesn’t hurt to distribute pink “Save the Boobies”-esque stickers, t-shirts and wrist bands. It’s acceptable to say “boobies” in polite company, to broach the subject of women’s health, and this push to pink-out everything has resulted in more funding for cancer research. People probably think it’s cooler to have “boobies” on your wrist band than something like “Save the Pancreas”, the cancer of which has a much higher mortality rate. But a pancreas doesn’t look as good in a bikini top.

There is a darker side to this, and it has nothing to do with the usual arguments against pinking everything out, which tend to be about companies making profits at the expense of women. This is about what it feels like to be diagnosed with breast cancer.

At some point, awareness hits a saturation point. I’m willing to bet that many women who have been diagnosed with breast cancer dislike the color pink on some level. The diagnosis is life-disrupting if not traumatic, and the constant reminder from all the pink ribbons and other paraphernalia can get nauseating. And I do mean that in a physical sense. For me, diagnosis = anxiety; anxiety = nausea; pink = breast cancer…well, math was never my strong suit, but this all adds up to pink = nausea.

As I sat alone waiting for my surgery, feeling very nauseated, my Nurse Navigator paid me a visit. Incidentally, these nurses are the greatest thing since sliced bread (probably even better!), as they are a knowledgeable liaison between the patient and everything medical. In any case, my nurse brought me a goodie bag. Yes, it was pink and it contained various useful items relevant to my surgery and future treatments. And yes, most of these items were pink too. I guess these days it’s hard to justify using any other color if you’re talking breast.

But there was one thing that was not pink, and it’s because it wasn’t pink that I realized right then and there what sort of a visceral response I’d been having to all the pink stuff. It was a soft and springy heart-shaped pillow to be placed in the armpit to comfortably support the affected arm after surgery, and it was purple. Okay, with pink accents, but close enough. It was PURPLE!

PurpleHeart

This is a good place to mention that I make strong associations between emotions and my environment. This is a form of contextual conditioning. I’m sure I’ll write more about that in the future, but for now, I can tell you that having something not-pink that I used daily until my incisions healed, and having it be completely relevant to breast cancer treatment…but again, not-pink…actually took the edge off my anxiety. I was more likely to reach for it because at a time when I needed to relax and recover, the color didn’t remind me of my cancer.

That may sound unbelievable, but contextual conditioning is like that. I love that pillow and I love that it’s purple. And it’s really pretty amazing how my brain perceives that squishy little purple pillow as being so nice to have around. Don’t think I would have had the same response had it been pink.

A Year With Tamoxifen

One of the most distressing parts of going through cancer treatment was that I thought it would “ruin everything”, even if it saved my life. Physically, I was really enjoying my 50s and hadn’t noticed much of a drop in endurance and strength, and certainly wasn’t experiencing menopausal symptoms. But with my diagnosis came the news that, because I had an estrogen receptor positive tumor, I’d need to be taking estrogen-blocking Tamoxifen (or an aromatase inhibitor) for a decade.

A decade is a long time! Chemo was only six courses over about four months and radiation lasted only six weeks — all time-limited and psychologically doable. But Tamoxifen would be with me for ten years, and presumably, so would the troublesome side effects, according to just about every woman who was taking it. They spoke about how difficult it was to stick to the daily regimen, knowing that it was responsible for horrible hot flashes and night sweats — one woman even said that she couldn’t exercise due to the severity of her symptoms.

Not exercise?!?! My version of hell: a sedentary existence.

At this point, I was busy dying a thousand deaths. I started to question whether death by cancer was a preferable alternative to a decade of misery. Mind you, I hadn’t even begun taking Tamoxifen yet; all of this was fear-driven. I feared having no control over my own existence and the things that really mattered to me. Basically, this was an end to life as I knew it.

So, fast forward to today. I have been on Tamoxifen for a year. I’m still waiting for the misery. Please note, I do not, for a second, doubt that women struggle with Tamoxifen’s side effects and I have the utmost sympathy for them. I also realize that I’ve been very fortunate so far to not have those types of symptoms. Sometimes I feel a little warm and have to roll up my sleeves or take off a sweater. Being in stuffy rooms can feel uncomfortable. But these don’t constitute what has been described to me as a hot flash, and I cannot recall whether I had those same sensations prior to treatment. Before my diagnosis, I’d had some sweaty nights from stress; I haven’t had a single night like that since starting Tamoxifen.

I do have some memory issues, particularly distractibility and loss of focus. Sticking to one thing at a time is an absolute necessity or else I’ll get sidetracked. My libido took a hit too. But is that Tamoxifen, effects of chemo…or just the onset of menopause?

The bottom line is, I had beaten myself up over potential effects of a medication way before I’d experienced it. I’d ignored the number one rule of cancer: everyone’s experience is different. Oddly enough, that had been the mantra I repeated to everyone else, but I’m the one who needed the reminder. For me, Tamoxifen has not turned out to be the torture that I’d expected.

If there’s a take-home message from this, it’s that cancer is a complex disease and its treatment is equally complex. Just as there is personalized medicine, there are individual reactions to that medicine. I, for one, have convinced myself that I need to stay off the Internet, take a deep breath and have my own experience.

When Deep Breaths Don’t Calm

It’s an obvious understatement to say that getting cancer is stressful.

My treatment plan involved a lumpectomy first, then chemo and radiation, but just getting to the surgery wore me out emotionally. I’ve written before that I’d never experienced anesthesia before, certainly never had major surgery…and add to that, the surgery would confirm how far my cancer had spread so I was apprehensive about the whole thing.

Suffice it to say, I didn’t handle this process well. Two weeks prior to surgery, I had begun a mindfulness meditation practice at the suggestion of my radiation oncologist. This was a life-changing step for me, but I hadn’t had enough experience with meditation for it to truly benefit me as I was sitting in the “ready room”, waiting for my surgeon. I knew I had to breathe, but it was hard to focus when I was terrified.

The “breathe deeply” mantra was repeated by a number of nurses, probably because I looked like a wreck. I can honestly say that breathing deeply, as hard as I tried, didn’t work. Months later, I came across an article (and unfortunately, I cannot recall whom to credit for this) addressing this issue. The problem with focusing on the breath during periods of extreme anxiety is that the breath is most obvious in the center of the body. You know, right where your racing heart is. I couldn’t separate out the two, and as I was trying to slow my breathing, I was acutely aware of the pounding in my chest.

So, here’s the advice that I would give now: find a comfortable position and focus on your hands. Feel into them and focus on any sensations present in them. Fingers are sensitive, so it’s likely that you’ll feel something. Is there tingling there? Are they numb?What’s the texture of the material that they’re resting against? If you feel nothing, rub your hands together and focus on those sensations.While this type of meditation (essentially a body scan) is often done with eyes closed, depending on the individual and how frightening the surroundings are, it might even work better to keep the eyes open and look at the hands. But really look, so that you draw your attention away from the beating heart, and then gradually try to slow your breathing.

The idea is to keep your attention away from parts of the body that remind you of how anxious you are.

I can’t say that I would have completely relaxed had I known to do this. I had been dealing with runaway anxiety for the past weeks that my rudimentary meditation had only begun to chip away at. But it’s possible that I would have gotten myself into a more comfortable state as I waited for surgery. Definitely worth trying the next time you find that a breath focus doesn’t help with anxiety.

What Is Up With My Hair?

But let me back up a bit. My hair has been an issue throughout all of cancer treatment. As everyone knows, the hallmark of a cancer patient is a bald head. That’s pretty unmistakable. Being told you have cancer and waiting for test results is anxiety-provoking because — besides the obvious fact that you have freakin’ cancer — you don’t know the extent of your treatment. Being told you don’t need chemo is a huge plus. For me, this was because then I wouldn’t be a “full Monty” cancer patient, and my perception was that my condition would not be quite as serious as if I were going all in and having to undergo the full spate of treatments (surgery, chemo, radiation). The reality of this is debatable, of course, but for me, finding out that I needed chemo meant giving up hope of all normality. This wasn’t going to be like taking a prescribed medication. This was going to change me physically, and everyone would know.

I didn’t shy away from telling people of my diagnosis, particularly those who were going to see me on a frequent basis. I mean, who was I kidding?

I’d always had long-ish hair, but when it started coming out by the handful, the thought of leaving a hairy trail in my wake was unbearable. I entreated my husband to get the clippers and off everything went. My daughter was supposed to film the entire thing (I was bound and determined to record my experiences for posterity) but this whole episode was a little overwhelming and I started crying…and my sweet kid didn’t want to film a breakdown so she only took stills. I really wanted the video, but whatever. At least I had photos. My husband had fun leading me through an evolution of punk haircuts that allowed me to relive the 80s, but when it was all said and done, I felt better and promptly sent out the photos to close relatives. I got compliments on my headshape and was told that I had dainty elf-like ears. The world of cool Halloween costumes opened up for me.

And man, did I look weird.

So, for the next however-many months I was all about scarves and hats. I got used to always having something on my head because my dream of being the “cool bald chick” didn’t materialize. With my hair gone, I had a very good view of my scalp, and it looked terrible. I guess being a Northern European in a city on the same latitude as Morocco was not kind to my skin, and my scalp displayed the abuse it had suffered all those sunny, hatless days. I had some pretty incredible moles, and, look, I already had breast cancer – I didn’t want to have to deal with skin cancer too. My lid stayed capped.

Now, everything-hair was in a holding pattern until the end of my chemo. First of all, when you google “Taxotere” (one of my chemo drugs) and “hair”, the first entry that comes up is for a law firm that is planning a class action suit against the makers of Taxotere on behalf of all the women who suffered permanent alopecia after taking the drug. This is NOT what you want to see.

After all that, I was pretty impatient about hair regrowth. There is a small percentage of women who do not get their hair back, but it doesn’t matter how small that percentage is. When you’re holding your breath and waiting for your hair to return, you’re convinced that you’re part of it. To make matters worse, my hair had gone all white/gray so it was even harder to see. I gave in to the folly of reading about other women’s experiences with regrowth, and they all seemed to grow hair more quickly. Or not at all.

By this point, I looked like a cross between Yoda and Gollum, since a few crazy hairs had apparently not gotten the memo and decided to keep growing throughout my treatment. Not a lot, just enough to make my scalp look like it was undergoing an identity crisis. My eyelashes were still clinging for dear life, and I had high hopes of being able to emerge on the other side of this journey with some fringe around my eyes…but no. A few weeks after chemo ended, all but a couple of my lashes went the way of my eyebrows. Gone. Nothing quite like being hairless to make you look like an alien from a 70s sci-fi flick.

So I waited. I whined in my oncologist’s office, and cried in my counselor’s. I don’t have much faith when it comes to being patient and seeing how things turn out. My impatience was driven by fear. Every trip to the bathroom was another opportunity to stare in the mirror, trying to determine was that a shadow or a new hair? This was complicated by the fact that my previously excellent eyesight is changing and I’m not adjusting well to that. I forget to bring reading glasses and think that the world has just gone fuzzy, like that’s perfectly normal. To my glassless eyes, I still looked bald.

But at one point I was examining my forehead, where the hairs reeeeeally took their time coming in (what’s up with that???), and saw teeny translucent sprouts. Finally? Trip after trip to the bathroom mirror, squinting from every angle, the hairs were unmistakable. Yes, foreheads are great things, but I didn’t need so much of mine. And finally it was getting coverage.

Let’s fast-forward to now. I have hair. It’s white and I look like my kids’ grandma. But regardless, I have hair and that makes me so happy. Let me say it a few times: hair, hair, hair! And not only do I have hair, I have gravity-defying hair. It’s a few inches long and reaching for the stars. I use hair styling products with names like “taffy” and “putty” to keep it in place, but when I wake up in the morning I look like a Pomeranian. I didn’t even realize my hair could do that.

Note that I am not complaining. My eyelashes came back. My eyebrows didn’t, but that pulled me into the creative world of brow design. Once I got past the “my-brows-were-drawn-by-a-five-year-old” stage, I got into the look and expanded the rest of my make-up to balance my face out. In the end, I look more put together. At the same time, I don’t look like my old self. But perhaps that’s not so bad – I am not my old self inside, and that’s being reflected on the outside. Yes, sometimes I walk past a mirror and shock myself, but this journey has been transformative and I’m going to have to get used to that. As with everything, deep breaths.