Anna's Book of Days

I'm out of surgery now and resting comfortably in recovery. The procedure was successful from a surgical standpoint, but we won't have the results of my pathology until next week. I'll most likely be in the hospital for the next two nights and discharged on Friday. I don't plan to do a lot of writing while I'm in the hospital (who know what I'd say while on this heavy pain medication!?!), but I'll post again when I'm settled in back at home. Thanks to everybody for your well wishes and healing vibes!

The envelope of a healthy breast (the skin surrounding the breast tissue) receives most of its blood flow through the breast tissue underneath it, with a much smaller amount traveling through the skin. A mastectomy cuts off all of the blood supply from the tissue, leaving only the blood supply from the skin. This supply can be inadequate, and when it is, the skin dies. The goal of a skin-sparing/nipple-sparing mastectomy is to keep the breast envelope, including the nipple, alive and healthy - but skin necrosis is one of the risks. The nipple delay procedure that I had is one of the ways that the risk can be mitigated; another is hyperbaric oxygen therapy, or HBOT. "Hyperbaric" means "increased pressure"; in HBOT, the patient is enclosed inside a pressurized clear acrylic chamber, breathing 100 percent pure oxygen. The air pressure in the chamber is twice the normal atmospheric pressure at sea level. In addition, the air we normally breathe contains only 21 perc...

The clinical trial requires that patients have a breast ultrasound within a 14-day window before surgery. I had tried to get out of doing it after I realized how sore I was from the delay procedure, but Dr. Hurvitz asked me to at least try, for the sake of the integrity of the study. So yesterday I went back to Radiology at UCLA for the first time since I had my first ultrasound last August. By coincidence I was in the same exam room as I was on that day, and as I lay back on the same bed I remembered how five months ago I had walked into that room thinking everything was fine, and walked out knowing in my heart that I had cancer. To my relief, the tech was gentle and the ultrasound was not particularly painful. She imaged the locations where my tumor had previously appeared, and this time there was nothing there. This was what I expected based on my previous clinical exams, where Maddie couldn't feel a distinct tumor anymore. However, the tech then moved the transducer furthe...

We just met with Dr. Funk and got the pathology report from the delay procedure - everything was benign! Three sentinel lymph nodes, left subareolar disc, right subareolar disc, and a mole that was under my right breast - all benign.  Dr. Funk also said that my incisions look great. At my support group this morning I said something to the effect that I know February is going to be a shitty month, but then it will be over and things will get much better. One of the other women, a very sweet person, said happily, "And February is the shortest month!" I got a good laugh out of that, both there and later with Seth. We have to take our silver linings where we can find them these days.

Over the last few months, I've had a growing awareness that as a seriously ill person, I should have some kind of documentation in place about my wishes should things take a turn for the worse. Really, every adult should, and I realize now that I at least should have done it prior to giving birth - but as a young, healthy person, it really just wasn't part of my consciousness. Until I started looking into it, I was pretty hazy about what the different types of documents were and what the terminology meant. I learned that a dvance health care directive is the general term for a legal document that spells out your decisions about end-of-life care ahead of time. Advance health care directives generally include two important components: a power of attorney for health care and a living will.  A power of attorney for health care names your health care agent (also sometimes referred to as a health care proxy), the person you designate to make health decisions for you if you are una...

The delay procedure is done! Everything went fine and we're home now. Dr. Funk said that both the breast tissue and the lymph nodes appeared to be benign, although we won't know for certain until the pathology report is done (we should have those results on Thursday). I'm in a bit of pain, but it's manageable - it's actually not much worse than the biopsies were. It's funny how the idea of pain is so much worse than the pain itself. And now for a nap...

To optimize recovery from operations, Dr. Funk recommends the following regimen of supplements and drugs to her patients, where Operation 1 is the nipple delay procedure, Operation 2 is the mastectomy, and Operation 3 is the implant exchange. To enhance wound healing (for each operation): A) Vitamin C: 1000mg tablets; one tablet once daily for one week before and one week after surgery. B) Multi-Vitamin: one tablet once daily for one week before and one week after surgery. C) Zinc: 50 mg; one tablet once daily for one week before and one week after surgery. To reduce the risk of infection (Operations 2 and 3): D) Bactroban ointment: Applied twice a day beginning 3 days prior to surgery x 7 days. E) Hibiclens shower: Hibiclens soap applied to upper torso and abdomen – left on for 5 minutes, then rinsed. Applied once a day for 3 days prior to surgery. F) Keflex: 250mg (antibiotic); one tablet 4x a day for 7 days, beginning with 2 doses the day of the operation. To reduce postope...

I just heard from Patient #3 in my trial, who just had her surgery (bilateral mastectomy with DIEP flap reconstruction): "Recovering at home now. I received info yesterday that my pathology report showed zero cancer! Makes the pain of recovery bearable. Each day a tiny bit better. I look forward to seeing you when I am feeling more mobile." So that's three of three patients with confirmed pathologically complete responses to the drug regimen that I am getting!

Lymph nodes are small round organs that are part of the body’s lymphatic system. They are found widely throughout the body and are connected to one another by lymph vessels. Groups of lymph nodes are located in the neck, underarms, chest, abdomen, and groin. A clear fluid called lymph flows through lymph vessels and lymph nodes. Lymph nodes are important parts of the body’s immune system. They contain cells that monitor lymph for the presence of “foreign” substances, such as bacteria and viruses. If a foreign substance is detected, some of the cells will become activated and an immune response will be triggered. Lymph nodes are also important in helping to determine whether cancer cells have developed the ability to spread to other parts of the body; many types of cancer spread through the lymphatic system, and one of the earliest sites of spread for these cancers is nearby lymph nodes. In the past, ten or more underarm lymph nodes on the cancer side were typically removed in...