Last One

If all goes well,
I had my last mammogram today.
Like last - as in forever!
Wahoo!!!!!

I have been having a mammogram or Breast MRI's
ever six months since being diagnosed.
With the mastectomy and reconstruction I will have done soon,
I will no longer need either.
I won't miss them.

Next month I go to Salt Lake to meet and have a consultation with a plastic surgeon.
I have heard a lot of scary things about the type of reconstruction I want,
but I have also seen a lot of amazing results.
It is a very complicated surgery - micro surgery.
Surgery can last anywhere from 4 to 12 hours,
with at least 3 surgeons working simultaneously.
The hospital stay is usually 5 to 7 days, the first few being in the ICU.
Recovery is hard and long too.
Basically they want you moving,
but no cooking, cleaning, bending, lifting, stretching, climbing stairs...for months.
It can not all be done in one surgery so it is done in phases. 
Usually 3.
I hope to have all of them done in one year.
That is why I am starting in January.

The procedure is called Deep Inferior Epigastric Perforator or DIEP flap.
Simply - you are cut from hip to hip below the belly button.
They dissect the fat and skin from the muscle and relocate it to the breast.
Since fat needs a blood supply if the vessel in the chest wall are not big enough or ruined from, say radiation,
they will break a rib and tap into the blood supply there.
Then they pull, sew, stitch and glue everything back together.

Here is all the technical stuff:
A DIEP flap is a microsurgical breast reconstruction where skin, fat and the associated blood vessels that keep it alive are transplanted to the chest wall from the abdomen during the Stage 1 Procedure. No muscle or motor nerves are sacrificed in the execution of this form of breast reconstruction. Blood vessels of the flap are connected to either blood vessels in the chest wall or under the arm in the axilla using an operating room microscope. Unilateral and Bilateral DIEP flap breast reconstruction can be performed in a 4-12 hour general anesthetic in the setting of a 5-day hospital stay with a focus on flap monitoring. Blood thinners are administered to prevent deep venous thromboses or pulmonary emboli. Sensory innervation can be supplied by the incorporation of a sensory autograft. Costochondral cartilage or rib resection is uncommon unless you are a very petite woman.

Stage 2 of this reconstructive technique involves the aesthetic shaping of the breast reconstruction flap and the completion of any counterbalancing procedures of the remaining breast (breast reduction, breast lift or breast augmentation). It is typically done 3 months after Stage 1 but can occur later for patient convenience. Excess skin from the flap previously placed for perioperative monitoring will be removed. Revisions to the donor site include liposuction and scar revisions. Nipple reconstruction is completed at this stage. On occasion in the irradiated patient, nipple reconstruction is deferred to a later date allowing for the revised reconstruction to settle, therefore optimizing nipple placement. Stage 2 procedures can be completed in a 2-hour MAC anesthesia in an outpatient setting.
Areolar reconstruction will be completed as a Stage 3 procedure in 2 months in the office.

DIEP flap breast reconstruction has been associated with mild buldging of the abdominal wall but with a significantly decreased rate of abdominal wall weakness or hernia. It has not been associated with post-operative back pain. Common complications are seromas or collections of fluid under the skin that may require needle aspiration.
DIEP total flap failure can be seen in less than 1% of cases.

DIEP total flap failure is diagnosed prior to your release from the hospital. Most patients with a failed DIEP flap undergo a secondary microsurgical flap procedure during the same hospitalization or at a later date, typically at 3 months, in the form of an I-GAP flap.

DIEP partial flap loss is commonly referred to as fat necrosis. Fat necrosis can present as a firm area of the breast reconstruction flap where the blood supply was not adequate enough to keep the tissue soft and viable. It likely represents an anatomic variant of the individual (not unlike a "hole" in your Christmas tree), OR possibly the poor choice of the perforating blood vessels to support the flap reconstruction.  To avoid fat necrosis a pre-operative CT or MR angiogram is done so your procedure can be based on the most robust blood vessel of your abdominal wall.

PS In case you were wondering, I do NOT recommend googling a video of this.

PPS The mammogram came back - stable mammographic appearance.  No new concerning microcalcifications.  Benign Findings
Another Wahoo!!!

Where Is My Epiphany?

Where Is My Epiphany?
By Nancy Stordahl

Do you ever wonder what great lesson(s) you’re supposed to have learned from cancer?
I have wondered.
This is another cancer expectation that’s out there and continuously perpetuated.
We’re supposed to learn from, and therefore potentially be grateful for, the life “detour” that is cancer are we not?
We are supposed to be transformed into a new and improved version of our former selves, right?
I often read articles about cancer survivors proclaiming to be transformed, enlightened, improved upon, bettered, or whatever.
It seems many have experienced some sort of epiphany.
And I’m happy for those individuals.
 I mean that.
That is not sarcasm.
But it just hasn’t worked out that way for me.
 
Sometimes I wonder if perhaps I’m a slow learner or something.
Sometimes I wonder if someone forgot to give me my copy of the, “how to properly do and learn from cancer,” handbook.
That is sarcasm.
After five years, actually after ten years if I count my mother’s cancer experience,
I sometimes feel I should be enlightened about many things by now.
About what I have no idea.
I wish I did.
I really want to know…
  
And what is an epiphany anyway?
In this context, it’s generally defined as a revelation, a sudden manifestation, or realization about the meaning of something; an illuminating discovery.
Well, that has not happened for me.
Sure I have picked up some nuggets of wisdom during the past five years, but a lot, maybe even most of the stuff I have learned from and about cancer, is totally shitty stuff.
In fact, I was thinking about writing a blog post with that exact title – 10 Shitty Things Cancer Has Taught Me – or something like that. There are way more than ten things too.
But I probably shouldn’t publish such a post if I should end up writing it.
Maybe I shouldn’t have even published this one.
Because you know, the positivity police are always out there.
Okay, so I’m being rather sarcastic in this post and cynical and maybe even a little grumpy.
So what?
Sometimes I get weary of all the cancer expectations and cancer language nonsense out there,
much of which makes no sense to me.
And okay, sometimes I get cranky too.
And I sure would like to know…
Where is my epiphany?

I feel this way a lot.
What am I supposed to be leaning from all of this.
Is there something to learn.
Or does it all just suck and it's bad luck.
Is there a reason for all this.
Actually I think I have more questions than ever,
and a lot fewer answers.
At least I hope I have become a more understanding and sympathetic person,
not just more tired one.