We got sent home yesterday.  Having the chest tube out of my left flank improved the pain issue quite a lot.  It left me with a small apical pneumothorax, but I had that last time and it resolved.  I could tell my nurse wanted me to consider staying another night but I did get better sleep last night than I did in the hospital.  He wanted me to feel safe about a pleural effusion not coming back.  I'm not gonna feel fine about that for probably a month. 

They did send me out with a JP drain, which may get pulled today.  If there's any doubt that it's putting out more than 30cc over 24 hours, I'll keep it another day, and get it out myself tomorrow.

My kidneys are working energetically (they dumped a lot of fluid in me intra-op), my gut is needing to be coaxed to wake up.  Pain is not as bad as the first surgery.  I can get out of bed by myself, for one, and I'm doing okay movin around.  I need to stretch my chest out more, and it doesn't feel good to do this.

I've got new scars on my chest, a smiling line under my left breast now, clockwise up to my sternum.  The left side is pretty bruised, and theres' a matching purple bruise on the left arm.  It's not too horrible.  I can only pull 750cc on my incentive spirometer, and can't sleep on my left, but I can sleep on my back and my right.  Some more walking at home on the track should help a huge amount for those things.  Chest stretches, which hurt a lot but will help with all my fancy scars.

I guess what happened to the ribs is that they had fractured, and begun to knit together underneath the bar.  There's no doubt this needed to be fixed with surgery.  The hardware looks a little like a bike chain on the CXR; it's longer than I expected.  I'll upload when I have all the imaging.  She actually didn't do plating with the cartilage.  She cut it in places, and then tied it with fiber wire to the bars.  I was a little loopy and craning my neck to see that when she was going through it in the hospital, so today I should have a better understanding of what was cut where.  It is possible, but not probable that the cartilage will adhere to the bars.  We'll find out in 2.5 years, but she thinks it will not. 

So, yes, am using MS Contin, but only 15mg instead of the 30 from last time.  And I have had no oxy since I left the hospital at like 2something yesterday.  Back on ibuprofen 800.  Miralax (bleech), and the moxy-floxy at night. 

We go for another CXR today, then meet with Dr. J, and then hopefully I can get all my imaging.  Mark wants to take me out to dinner (I'm less enthused by food in general at the moment). 

And now I get to think about cancer.  If it were just this surgery, I could probably be back to work after two full weeks.  (So...probably October 12.)  The pain isn't that awful.  I need to stretch more and I need to walk more and it's August in Phoenix.  Mark is making me use my IS.  But once I deal with some business today (making follow up appt with PCP, doing health history forms for the breast center people), I fully intend to bury my head into playing Skyrim, and slaying dragons. 

I am grateful to Dr. J, you know.  I was really upset by the infection, yes.  But because of this surgery, we found the breast cancer I was going to inevitably get early.  I told her that.  So.  um.  yay. 

This isn't the stupidest year of my life.  I thought it through yesterday, and stupider years were:  2012, 1990, and 2005.  Maybe in that order.  Fifth grade wasn't that fun, either, come to think of it...1981.  Probably cancer is worse than Sr. Maura was....but you know, that's a bit of a toss-up.  You wouldn't be able to convince 10 year old me of that.

I think 2017 should be a good one, thoough.  I have decided.  I should also think of really awesome years, too:  2011, 1993, 1998, 2002. I think 2017 should be awesome.  And that's only four months off.  Four months is enough to get rid of some stupid cancer cells, I think.  Probably have more scarring and stuff on my chest.  And I'm going to have to be even pickier about bra-shopping (and this is something I am picky about now.)  I don't want any boring beige bras, either, ones that scream, "I see the softer side of Sears."  If Rupaul's girls can wear extravagant, jewelled corsets and they have no breasts at all, I should be able to do the same thing.  Maybe THAT's where I need to go bra shopping...Victoria's Secret has let me down several times now.  I need to go down Broadway to the shops that have size 20 stilettos. 

Yes.  I need an absolutely ridiculous, gorgeous bra worthy of Drag Race.  After all of my doctor appointments next week (er...this week, now)....that's where I'm gonna go, hunty.

But for today, I'm going to drink Miralax and kill dragons.

So it's 8am post op day 1, and I'm up in a cardiac chair and my nurse, Robert, brought me toradol and coffee.  This makes him the best human ever in my book.

I have a Dilaudid PCA, and I banged on it 14 times overnight (four of which were before and after I got out of bed this morning.)  So if I sound disjointed and fuzzy, it's because I am.  I also have a pulseox on my left middle finger, making it difficult to type the letters e, c, d, and I keep putting extra r's and f's in things.

Have not seen Dr. J or her PA post op.  (Or if I did in PACU, I have no reollection of it.)  Since it's Saturday, I'll probably see the PA.  She fixed the ribs, and I asked her to fix the cartilage, too.  She had heard from Kelly that the breast cancer was on the left, and was concerned about putting more metal there...and then proposed we wait until the bars come out in April 2019.  And I don't want to have another big surgery looming ahead of me.  So she plated it.  I don't know what I look like yet.  I've got a foam dressing and a binder over it. 

I've got a chest tube in, which has put out almost nothing, so hopefully that will come out today and my pain will immediately improve by leaps and bounds.  I've got a JP drain in, too, to suction (wall suction, not just the bulb itself, which is a weird setup).  It has put out 120ccs of serosanguinous...I'm not sure if it's submuscular? on the left?  I don't know, and I will ask.  My estimated blood loss from surgery was about 200ccs.  I don't know if that's normal for the modified Ravitch.  There was only 50 EBL from the original Nuss. 

She told me she had to make an incision under my left breast and up and clockwise medially.  More scars.  It's fine.  The scars don't bother me.  I'll just look tough in a swimsuit.

And I've got an IV in one of the worst places possible:  my left hand, between my ring finger and pinky...that little vessel there was all she could find.  I asked anesthesia to put one in my forearm once they fill me up with fluid, but maybe they couldn't find a vessel, either.  I did have an A-line for the case; I just took that dressing off.  And a foley, of course.  About an hour after Robert gives me my Lasix this morning, I want that out, too.

So we should be able to get rid of the chest tube, the foley, the continuous pulseox, and the PCA today.  And maybe I can persuade them to take the tele monitor off, too.

And yeah, I hurt.  Coffee makes it better.  Having it over with makes it better.  Dilaudid takes the edge off, but it doesn't do a whole lot more for the pain.  Makes me sleepy.  Like, I think I'm blinking for too long.  They didn't do the epidural, because of concern for infection.  So, okay.  The epidural would've been the best thing for the rib pain; but it's okay.  The toradol is kicking in, and it's all right.

So now I'm getting really sleepy.  I did sleep okay last night, considering I'm inpatient.

Robert's back.  I'll be back later.

We're on the plane to Phoenix to go have surgery to correct my stupid fractured ribs that are stupidly poking my ventricle, and maybe correct the carinatum that was created from the excavatum procedure and it all feels a little secondary right now.

And at the same time, I have the stupidest and most fixable of cancers, and have not a damned thing to whine about.

I got a coworker fighting the REAL fight with a cancer like an octopus of doom in her boob, and she's getting chemo. Which is poison. I'm a nurse, and I'm not supposed to say that, because it's poison that saves people's lives and I know that, too. I also know it's fucking poison. I don't know how to help her, other than to hug her and text her sometimes that she's awesome.

And I probably won't need it. Chemo, that is.

The standard treatment for DCIS is lumpectomy, with or without radiation, or mastectomy. With either option, possibly the drug tamoxifen for at least ten years.

Thank ALL the gods about the likely-no-chemo thing. (I haven't talked to any of them lately. Maybe I should. Maybe Isis is up on the latest research on DCIS, I shouldn't dismiss out of hand that she's hasn't got an opinion on these things.) (I should ask.)

Yeah. It's fuckin cancer.
….

I've been expecting a diagnosis of breast cancer for 13 years, since my mom was diagnosed at age 53. She had DCIS, too, mildly invasive but at a lower grade than me.  Have never been pregnant, much less breast-fed.  Was on oral birth control for a solid 20 years, and then switched to an IUD with the (much smaller dose, but still present) hormone release.  At age 44 and 3/4, I am a recipe for breast cancer.

Oh. I've been learning cancerspeak. It's another language. Let me help translate.

I explained it to Chase last night, and I'm partly making this up maybe. But maybe not and maybe this makes sense and is correct....or correct-ish. I have ductal carcinoma in situ (DCIS). Ductal is obvious...it's in the ducts of the breast. From which milk would emerge, if you've done that sort of having-a-baby thing (which I have not). Carcinoma is obvious....-oma is some type of tumor thing that doesn't belong there. In situ means in place. So. DCIS means cancer of the ducts that emerged from there and is sitting there.

I told Chase, who likes science, and had biology, to look at it on an X-Y axis of seriousness. Invasiveness is one of the axes....mine is not invasive, as far as they know right now. Yay for me. My mother's was mildly invasive.

Another axis is the “mitoticness” of it....which may not be a word, but he understood. Mitosis is the process through which cells divide, and the degree of this is graded. Mine is a high grade, so my little cancer fucker cells are breeding like fucking rabbits. They need to die. Now. So this is bad. Or, maybe, more accurately: less good.

DCIS is still the best breast cancer to have.

Yay. Me. Woo....?

I have THINGs to DO and this cancer shit is REALLY inconfuckingveniencing me. Sorry. I dropped a lot of F-bombs after my biopsy too. I kept apologizing, but I couldn't seem to stop it. Angie was my radiology tech and she was the awesomest person ever. Then Asmet helped me with coordinating the biopsy, and she was completely awesome, too. The two of them were there for my biopsy, with Dr. Amy. I really did have the A team, literally and figuratively. I couldn't have asked for better people to take care of me.

Mark is taking care of me, too. He is worried. He doesn't know cancerspeak either. This stupid crap is new to both of us. We'd rather be doing something else.

When I'm unconscious for THIS surgery tomorrow, I am going to let him have the books I got from amazon.com. (Of COURSE I got books from amazon.com. I met the Fedex guy at the door, twenty minutes before we left for the airport. Only because I want the patient's-eye view before I start going to town in PubMed. I love that I have free and easy access to PubMed because of my job.)  One was a funny cancer book, the other is not.  I read the unfunny one until I can't, and then I switch to the funny one until I can't and flip back and forth.

So. I'm okay. I am deeply grateful for the people in my life. My mother-in-law called today. My father-in-law (who just got home from France) called yesterday. My colleagues have been fantastic. I am a lucky bastard.  I am really happy with all my UCH doctors.  My PCP called an hour after I got off the phone with the pathologist, and asked me to come see her for my mental health.  I suppose I could take that as, "Michelle, you are either now, or about to become, a complete emotional wreck and you need to be medicated for your looming DSM-V diagnosis."  But I didn't.  I think it was kind.  I think she cares.

The weird thing (or, not weird) is that if I hadn't had the pectus surgery, this little shit of cancer would probably not have been found, because it was living...squatting without paying rent, or cleaning up after itself....in the medial aspect of my right breast, deeper into the tissue. Completely inaccessible to a mammogram last year. Little fucker.

Sorry about all the swearing. Just, you know. I am learning that cancer makes you swear...a lot more than you typically do

So.....yay? That I had this surgery....and I got infected and found out via CT scan that I had a bone poking my ventricle....? And then I felt a lump in my left, and got my annual mammogram “with diagnostics” right before this SECOND big surgery of the year and it would not have been found if they hadn't popped my sternum up.  I mean....yay, right?

When Mark, Chase and I were talking about it the other night...(god, was that only last night?)....we concluded that it was sort of a good series of possibly not-accidents.

Fucking cancer.

Next Wednesday, the day after we fly home from the OTHER Biggest Medical Thing To Happen To Michelle This Year, we go meet a multidisciplinary team: a surgical oncologist, a medical oncologist (read: chemo person), and radiation oncologist, plus a genetic counselor “because I'm young.” (What this means isn't really clear to me.  They'll be testing my genes to see how likely I am to have horrible cancer, I think.  I think we've already ascertained that I have failed the genetic and lifestyle combination crapshoot, so the purpose of this is not clear to me.)

I was talking to Erin, the Breast Center nurse, and said, “I just want this shit out. Like, now. I'm already gonna be on FMLA....how far out are you scheduling lumpectomies and mastectomies?  Because I will do it next week if you'll let me.” She said 1 – 2 weeks for lumpectomy, 2 – 4 for mastectomy. She asked, “If you're sure that you want a mastectomy, we could also have you see a plastic surgeon....?”

That threw me off, because I hadn't even thought about that yet. Breast reconstruction. Oh yeah. Women do that. I thought about it some, and left her a voicemail that sure, I would meet that person if she could arrange it because I would be open to hearing what he or she has to say.

I have written elsewhere in this blog how I have felt about a boob job for me. It's a sore point because some physicians erroneously believe that pectus repair is about body image issues.  There is literature out there that discusses body image and pectus.  Fine.  It's a valid area of research.  Some of us aren't doing this because kids are mean.  Some of us are doing this because we can't fucking breathe and we have tachyarrhythmias.  If I'd wanted a boob job, I would have gotten one a long time ago.  I did not want one.

I don't care what any other woman does with her body; it's her business. But ever since I was 18 years old, and that nurse practitioner, at my very first visit to Planned Parenthood, told me to go see a plastic surgeon....I have kept my body the way I am as a somewhat-unconscious hell-with-you to people who judge others based on their appearance.

My breasts were always significantly uneven because of the cavernous divot in my chest. Yes, I was self-conscious as a teenager, but what teenage girl isn't self conscious about her body? My good friend and hairdresser, Katie, has Eyebrow Issues...in the sense she's very conscious of them looking nice, and evenly spaced and....whatever else people judge eyebrow criteria on. Because she's beautiful and perfect, inside and out, and the only thing the mean girls in her Catholic school could come up with to make fun of her were her....eyebrows. Even the most beautiful of people don't like something about their appearance.  And chances are outstanding, you don't notice it.  Unless you're a jerk.

Girls and boys are mean. Alan Cox once made fun of me in the library in 7th grade about shooting a duck and its “tits flying off it's body,” but that would never happen to me because I had none. (Are you reading this, Alan? I love you, man, but, you were a mean kid in 7th grade.)

I look like what I look like. If it's not good enough for other people, not pretty enough, not hourglass enough, dude, totally your loss. My wonky right breast has never ever been a problem for any man lucky enough to see it up close and personal. It never got in the way of ...any of my social activities. Go pound sand, insensitive nurse practitioner who thinks 18 year old girls should get boob jobs. You are wrong.

I got a tattoo over my right breast about ten or fifteen years ago...long ago enough that the once-black ink is turning to that payne's grey that older tattoos have. I didn't think consciously about where I place it (because, honestly, a little inebriated at the time). But I didn't want the tattoo anywhere else. It was the body part I wanted....decorated?  Offset?  Feng-shui-ed?. In a permanent way.  I'm not sure I have the right word for that.  If there's a German word that means to place a piece of art next to something that reflects kindly and aesthetically shines onto something else that the art is near....that's what I mean.  (German has a vast vocabulary for ephemeral and yet hyper-specific things.)  (Maybe there's a Mandarin word for that, too.) 

At the time, my thinking was not that complex about it.

And so....they are offering me to make my breasts look...”normal.” With silicone and stuff. I think.  Women feel strongly about this one way or the other, and I don't know what to feel.

If you're thinking I'm putting the cart before the horse and that maybe they won't take my breast off....it's because I've been obsessively thinking about cancer for a whole five days. And I'm an efficient thinker.

I'm at a very high risk for not only getting diagnosed with cancer (which I have, at age 44), but having it recur. Something like within five years, I could be doing this crap again.  And having it be worse. And worse means chemo, which is a fate some people choose to die in lieu of doing. I may not have strong feelings about breast reconstruction yet, but I had strong feelings about chemo even before I watched my mother suffer through it.

No breast tissue, no breast cancer. No breast cancer, no chemo. Bada-bing. Yes, I could get colon cancer or lung cancer or cancer of my pinky toe or whatever, but I eat broccoli, don't smoke, and I get up and move and the whole point of this surgery this year was to go back to exercising like I used to....because when I can breathe, I like getting up and moving. I drink red wine moderately enough that my liver function tests say it's okay to keep drinking and don't eat anything with eyeballs. I do not skydive. I brush my teeth and floss. People like me shouldn't get cancer. Dammit. Nobody should get cancer. It's a stupid thing to get.

They may want to radiate me, which is complicated because I have metal bars in my chest. Yes, I've already told Dr. J. I got a call from Kelly today that Dr. J is strongly considering NOT fixing the carinatum I now have because she doesn't want to put more metal in my chest if radiation is a thing that may happen. I want her to fix the carinatum, though. We'll discuss it tomorrow morning.

So I have a lot of decisions. I'm a decisive person, generally, but these are not easy.

I think we might be circling Phoenix airport. We seem to be gently descending. We have to go get the car, get to the hotel, and I have to take a hibiclens bath/shower/something. And we have to get up at four thirty in the morning to go to the hospital so I can have a surgery that has nothing to do with this little fucker cancer in my right boob.

So. I have to go think about something else now.

Then this news below arrived today. 

FINAL PATHOLOGY DIAGNOSIS
 
A) Breast, right, 3:00, stereotactic biopsy:
- Ductal carcinoma in situ (DCIS), high nuclear grade, micropapillary and flat type with calcifications and comedo necrosis
- See comment
 
B) Breast, left, 12:00, N1 cm, ultrasound guided biopsy:
- Breast tissue with apocrine metaplasia, sclerosing adenosis, usual type hyperplasia and stromal fibrosis; features suggestive of a complex sclerosing lesion (radial scar)
- Negative for atypical proliferation or malignancy
 
Pathology findings are concordant with imaging findings. Surgical and oncologic management is recommended. Findings were discussed with the patient by Amy XXXXX M.D. on 8/23/2016. She plans to attend the Breast Center Multidisciplinary clinic on Wednesday, August 31, 2017.

I went and bought myself a bottle of sparkling wine, because....what else are you gonna do.  Got cancer?  You should have sparkling wine. 

I want to give special thanks to Angie and Asmet, (and also Dr. Amy), who took excellent care of me while I laid on my stomach (and ergo, broken ribs) for the biopsy.  And Mark, who took me for huevos rancheros after, and who's rolling with this well.  And Bex.  And Sam.  And Katy.  And Kate.  And Denise, and Felecia.

I told my mother and father today.  Mom took it better than I thought.

At least I'll be on FMLA already.  It could have been a million times worse; a coworker of mine is going through stage IV with chemo right now.  It's miserable.

So.  Cheers.  Gonna ask Dr. J what happens if you shoot radiation at the pectus bars...wonder if I'll cook like a gyro, inside out.

I forgot that I had the first date for revision surgery in the blog.  We fly out next Thursday afternoon, the 25th, to report to Mayo at 0530 Friday morning.  To still likely be second case.  They want me to do another CXR, labs, blah, blah.

People keep asking if I'm okay.  And it's wonderful, and I appreciate it and I'm deeply grateful for the concern.

And I lie and tell them I'm fine.  And it will be okay.

Because very often, they ask at work and it's quite inconvenient to have my eyeliner run, and blowing my nose makes my chest hurt again and it's just a bother.  No, I don't need to "let it out."  I realize that this is what Americans do, and it's a theory to which I used to subscribe.  Nurses are used to doing this for our patients.  It's called nursing. 

But I'm not stuffing down my feelings, I'm letting them be there.  I just don't need to feed them.  That Buddha guy had some good ideas, so I selectively borrow some of them from time to time.

Yup, I'm scared.  Yup, I'm anxious.  I cleaned the hell out of parts of this house last weekend, and completely ignored others.  I bought a body pillow that I am calling my Sqworm. 

If you follow the link to the website, you'll find soothing, soft-light daytime photos of blissfully pregnant women curled up with this thing.  It's brilliant.  I can't speak to how soothing it is to a pregnant person, but I think it's awesome.  It helps my posture at night, and sleeping has been easier.

See, through this....people who only had to have this surgery crap once will tell you it took them six months to get back to sleeping on their sides (for those that were before surgery.  I've been doing it for a month.  It is occasionally really painful.  But sleeping on my back was annoying.  Now I have a sqworm.  Yes, I do have a husband that I could curl up with, but he is less bendy, and he's 98.6 degrees, which is too hot.  The cats are hot, too, and they have claws and will sometimes inexplicably jump up out of bed. 

Having pain.  Like.  Admitting it now.  The ribs hurt.  They've been hurting for about two weeks in a different way than they did before.  Yes, could be psychosomatic.  But there's clicking involved, and I've never heard of psychosomatic clicking.  And it's different clicking than the bars.  Sometimes I can actually feel a pinch from one of those broken ribs.  Not enjoyable.  I think it's my sucky posture at work, which I keep trying to do better with.  Can't wear the pectus brace, because the point of that is to improve your posture by pushing down on the lowest ribs....which is a problem if those ribs are broken.  Probably.

But three weeks ago, I was taking nothing for pain.  No ibuprofen even.  It was awesome.  Now it's daily ibupofen at some point, and even occasional oxy at night.  (Yes.  I still have some left from April.)  (And at the rate I'm taking it, I'll have a new brown jar of it before I finish the old one.)  So, yeah.  Pain is a bother.  Weirdly dizzy today too. 

I'm going to chalk that up to stress of this surgery coming, or possibly a psychotic break, and Buddhically (I think that's a word), let it simply be and not engage with it.  Kinda like that crazy or mean or divorced-from or chain-smoking family member you have to see during the holidays, but over the years, you've managed to coexist with them on the same couch...without actually having to speak with them.  I mean, everybody's got at least one of those, right?

....

Yes.  I know there's an Olympic swimmer with pectus.  This is awesome for him.  Maybe after surgery, I'll watch that sport.  (I've been watching gymnastics and synchronized swimming, which I did not know was a thing.)  Hopefully, he's doing something about educating people that pectus exists, and fantastic for him that he's an Olympic swimmer with it.

I cannot swim.  My parents put me through lessons, and everybody was all disappointed.  They watched wistfully while my childhood (and current facebook) friend Amy Heilman overachieved me in this.  (She really is a good swimmer.)  My father is a very strong swimmer and he's tried to teach me.  Owen tried.  Bex tried.  I have always blamed this physical dumbness ON my pectus, because my body is not that stupid in other ways.  I've seriously biked and hiked and been a gym rat up through my early 30s, when I started to get the pulmonary symptoms.  I never learned to swim.  I do not float.  I sink.  So. 

Probably I'll watch when I have a higher tolerance for being reminded of what I cannot do.

Don't get me wrong; everybody who's said something about it to me mentioned it out of compassion, and this is very much appreciated.  I'll watch it later though. 

God knows, I've got a whole lot more time to bond with the television coming.  Cos.  You know.  I didn't just get two months to catch up on any show I wanted to catch up on.  I've been picking at the Olympics.  Because I'm hoarding it for later, because I already went through all my Law & Orders, Orange is the New Black, Buffy the Vampire Slayer, Game of Thrones, RuPaul's Drag Race seasons 2 - 8, the Godfathers, LoTR, Hobbits, Dunes (the doofy one with Sting AND the cooler one), and most of my Godzillas (Toho only.  Duh.)  Bex had me try The Man in the High Tower, which was awesome.  That was two months of freakin Netflix. 

(Don't judge....I tried to read.  I cannot read while on MS Contin.  I just stare at the page, looking at nouns and verbs and not remembering the plot.  It's freakin horrible.  I have a house full of more books than anything else in this house. And I could not read anything.)  (I do not understand why people enjoy narcotics.)

BUT!  A bright point!  RuPaul's All Stars Season 2 starts on the 25th!!!!  *SQUEEEE*  No, really, I'm so excited.  So, one of my medical assistants, Jemaine, loves this show, too.  He's leaving us to go to another clinic and I'm sad about that, and also sad that I was thinking I'd have nobody at work to pick apart my drag queen show with....BUT!  Turns out my new nurse, Felecia, loves it too!  :D :D :D :D YAY!   (Balance in the universe is now restored.)

I don't know.  Maybe I can learn to swim now. 

So.  Next week.  Absolutely nothing to report.  Just sitting on the metaphorical couch on Christmas afternoon, coexisting next to that doppleganger of me, full of anxiety and abject terror.  Ooh...you know what would make that better?

Having a drink in my hand.  Because THAT is how one gets through those Christmases.  I'm going to stop talking now, and go fix that lack of drink in my hand.

I will update here again.  Soon enough.