Countdowns & timelines

The countdown to my next surgery has officially begun. It is a week from today and although I'm more ready for it than anything, the anxiety is starting to brew again. There are less unknowns than the first surgery. Until the actual mastectomy in May we essentially didn't know what stage the cancer was in or if it had spread; the way to find out was to study the pathology and remove some lymph nodes. My treatment following the mastectomy depended mostly ON the mastectomy. So there was a lot of anxiety with that surgery: just having the cancer removed and also figuring out how far it had advanced, if at all.
With this surgery, we know the cancer is out, and we know from the first surgery it , luckily, hadn't spread to the lymph nodes. The anxiety here, this time, is about the margin. If my doctor can get a clear margin without cancer cells (the skin & muscle around where the tumor was will be removed), this could very well be it. Tumor removed. Check. Clear margin. Check. Then the reconstructive process would begin again.
But if the margin isn't clear, and this could mean one, two or both of these things, then more treatment likely is needed. 1. The doctor didn't get enough margin, meaning she wasn't happy with the area removed. 2. Cancer cells were found in the specimen that was removed. One or both of these things would probably lead me to radiation as the next course of action, to make sure everything is "taken care of" - cancer cells killed and recurrence prevented.
So much of breast cancer treatment is guessing and assuming. Doctors have been treating women for years and each year advance the treatment to make it better, or safer, or more efficient. And they're learning more each year, too. But the thing is, every case is treated differently, and the surgery or treatment has to be tailored to the patient; there is no "yes" or "no" or black and white. The doctors do what they think is the best and most efficient. Often, new treatment plans are created or initial ones are altered after they have begun, like in my case.
This second surgery, like I've mentioned before, is being done because my doctor wants to avoid radiation if possible. She thinks she can get a good margin through the surgery. At first I wasn't really sure about the decision, which was mine to make. I knew surgery was the right choice over radiation because radiation can be harmful, especially to someone who has had cancer before (twice now). It took maybe a few weeks to figure it out, but I realized that giving someone chemotherapy/radiation when they don't really need it would do more harm than good. From what I've read, doctors used to always give radiation and chemotherapy to breast cancer patients, and after much research and experience, they found it wasn't necessary, and could create more health problems in the future. They figured out they have to treat the affected area. Yes, in breast cancer cases where the cancer has metastasized - meaning it has spread throughout the body, of course chemotherapy would be needed. But in cases such as mine, where luckily the cancer hadn't spread beyond the breast, or with DCIS, even the area of origin, and nothing invasive was found, chemotherapy isn't really an option.
So, what we want is a clear margin. A good margin clear of cancer cells. But I also have to prepare myself that it may not happen. The outcome of this surgery, like the outcome of the first, is directly related to my timelines for wedding-related things.
In case #1, where a good, clean margin is achieved, reconstruction (meaning re-filling my tissue expander gradually), can begin 2 weeks after the surgery. This would put me in the area of October or November for my exchange surgery - where I get my permanent silicone breast implants.
In case #2, where either a good margin was not achieved, or cancer cells were found in the specimen, I would imagine, through previous discussions, that radiation would start 2 weeks to a month after the surgery. Six weeks of radiation, followed by a break to recover, would put me in the area of December or possibly January for my implant surgery. This does not take into consideration the saline fills, which either would or wouldn't happen all at once.
November or December is when my wedding dress will come in, and when the first of 3 fittings will start. I've got wedding things all throughout the fall and winter: bachelorette party, bridal shower, meeting with the Rabbi and florist, and appointments have to be made for a food tasting with the caterer, a "practice run" at the hair salon, picking out rings, etc. Luckily, much of that won't be interrupted. I was able to order my dress in July. Done. Flowers, caterer, music, venue, hotel block, rehearsal dinner ... done. We're nearly 7 months out and just a lot of little stuff is left to do, and most of it is already underway. The wedding planning and pre-wedding parties so far have been unaffected, essentially, by my current health situation. And I imagine they will continue to be, but it's still stuff I have to think about and sometimes worry about. Luckily, also, some of the stuff we have left to do can be done over the computer/at home, such as picking out and putting together wedding invitations, ordering a Ketubah, etc.
And I also have to look at it this way: no matter what I'm physically going through when doing these wedding things, whether it's a surgery recovery or radiation, it really won't affect the plans. Sure, the week or so after each surgery I'll be "out of comission" and unable to really go out and do stuf, but things CAN be accomplished at home or on the computer. So it's not really so much about my physical state or stage, it's about PLANNING these appointments AROUND my surgeries/treatment.
Which surgery will be upcoming, or completed, during the time of my bridal shower? Will I be recovering from something? What about my bachelorette weekend? Will things be over, or will more have to be done? These are the kind of questions I have. Essentially, the (hopefully) final surgery of me getting my implants can be , for the most part, scheduled AROUND my life since it is not a medical emergency. I would assume I could work WITH my plastic surgeon to schedule it in a way that works for me and Sean.
I will admit, I drive myself crazy thinking of these potential timelines, because we really don't know. But if I don't think about the timelines, I can't prepare. The ultimate goal is to have everything done, and me back to feeling normal, before the wedding. I have no reason to believe this won't happen, especially if my final surgery is in December - 3 months before the wedding. But still ... three months. It's hard for me to imagine everything will be "done" by then because I'm a little bit paranoid, and honestly, who could blame me after this "thing" popped up in the middle of my wedding planning and engagement?
I'm also trying to mentally prepare for what I'll go through physically, again, with this surgery next week. Though this surgery will not be as intense or painful as the masctetomy, it will still be pretty rough. The doctor is going to remove three layers for the margin: skin, fat and muscle, from what I understand. I think the muscle-removal part will hurt the most. But, I won't have any lymph nodes removed and I'll already have my tissue expander in, so that's nothing new, and by now, I've kind of (kind of -- let me stress that phrase!) gotten used to it. My plastic surgeon told me to expect about a week for recovery. Complete recovery will take longer I assume, but the point where I can go back to work and resume most of my normal activities hopefully will take about a week. I have to remember that I went back to work only two weeks after my mastectomy, and that was a pretty involved, 4-hour surgery.
So there will be the post-surgery medicines - some of which I do not like, such as Percocet - as well as the post-surgery "healing." This means for the first few days I'll have a bandage, followed by steri-strips for a week or so after. There's the being extra careful with my body and looking for any draining (sorry, that's gross) or signs of infection from the wound. And then there's the mental aspect of accepting new scars. I had kind of (still "kind of" here) gotten used to what I look like now with the tissue expander. But I find it mentally exhausting, and maybe even devestating, to see, and get used to all over again, new scars.
I try not to think too much about timelines because things will happen as they will, and I know deep down everything will be fine. Everything will work out great in the end. It's in my cards, our cards. It's what Mr. "Man Upstairs" wants. It's just hard to think about the "end" of this when I'm still very much in the center of it. I'm still in the "whirpool" I described in one of my earlier posts. I won't really know the timeline I'm working with until the results of this surgery are back, and this surgery isn't for another week. Days go by so incredibly slow when you're waiting for something like this: for answers, for a plan. And it's especially hard for me to see the timeline or the plan when A) most of it is dependent upon the next surgery, and B) when it's already changed once before. The "plan" is like this little floating cloud that I can't quite grasp yet, but soon, hopefully will be able to.
I know this post has gotten really long (I'm a writer, what did you expect?), so I'd like to end it, and on a somewhat happy note, too, because even after typing all this about the timelines and the unknowns and the guessing games, I still have quite a bit of hope this whole thing will work in my favor, in the end. This post also turned into less like a post and more like me trying to sort things out, but oftentimes that's what happens when writing.
Things just are. And they just will be. Much of this journey has been me trying to focus on what I CAN control, versus what I can't. I CAN be hopeful, have fun with friends, enjoy the little things in life, and continue my daily activities and plans. I CAN'T control cancer or my treatments or surgeries, and I surely CAN'T control what this cancer and these surgeries have done to my body. So, let me just carry on. Let me walk through, with my pink rainboots, the treacherous terrain that is this breast cancer journey. I picture myself pushing aside thorns and stomping through mounds of earth, and raising myself over fallen-down branches. Though not all days are like this, for the most part I feel I constantly am working through getting through this. It's a constant mental and physical thing. It's on my mind and in my body. I'm always working on getting through, one day at a time, to tomorrow, and then the next day, and the day after that. And that's what it is. I'm just getting through this. There's no answers right now, and the end of all this isn't here. And I can't control that, so I'll just let it be. This is me right now: I'm just walking, or crawling, or sometimes climbing, through. It will be what it will be. And for right now, it just is. Ok, so that's not a real "happy note" but it is acceptance, and for me, that's quite a feat!