The Long Road

In the last few months, many have asked the "What's next?" question, sometimes phrased as, "You're having more surgery?" Today, I'm fielding all such questions by telling you what I know.

My last round of chemo will be, God Willing, 16 November. I will continue to get the Herceptin treatment every 3 weeks for the remainder of the treatment year--that is, through August of 2010.

I'll probably get 3 weeks of radiation, 5 days a week. I say "probably" because I haven't met with the radiation guy yet, but this is what Dr. Science mentioned. We hope to do this in December so that we'll be done with all this stuff by the new year.

I'll also be taking some kind of drug once a day for 5 years that has to do with the estrogen supply to cancer cells. Something like blocking the e from the bad cells, but flooding my bones with it so they end up very strong, even after chemo. (?) I don't know. I'll be sure to fill you in once I learn about it.

Once the Herceptin is done in August, I'll have an itty-bitty surgery to remove the port. Mayfield says it can be done in the exam room. I look forward to this day because I plan to make a key ring out of it.

Now, early on, I mentioned my genetic screening for BRCa1 and BRCa2 (the unimaginatively named breast cancer genes). I did that screening before my surgery, and got the results back the day before surgery, at which time, I had other things on my mind.

The screening itself deserves a post of its own. Suffice to say here that if it comes up positive, the medical recommendation is to remove not only the other breast, but the uterus and ovaries as well because chances of developing cancer in these places, if one has one of these mutations, are through the roof.

And it's bad news for my daughter and my first degree relatives, and the daughters of my brother.

But my screening came back negative. So no one reading this has to worry.

(Note to sisters, however: You should tell your doctors at your next physical about me. My specific cancer is
1. ductal
2. HER 2+
3. estrogen receptive)

So, yes, thank God, there is not necessarily a genetic mutation lying in wait for Gemma.

I still plan, however, to have my other breast removed. It's very common practice to do a double removal when a tumor is found in one. (A young nurse during the port surgery told me this was her training and she was a bit confused as to why I had one breast. . .)

I asked Mayfield if we couldn't do a double at the time of my surgery. He said he would, but because the removal on the right was supposed to be a radical, including a portion of my pectoralis, and because I was also getting a port installed on the left side, there was reason to avoid the additional trauma of removing the left breast.

Why plan on this surgery now?

Two big reasons, both so big, there's no point in deciding which is bigger.

1. My chances of developing cancer in the left breast are now 4 times greater than normal. I'm 34 years old. Seems like we would look at those years and those odds and think, "It's not 'if,' but 'when.'"

And, sure, there's a chance I wouldn't develop cancer on that side. But do you know what I know for certain? I do not want to do this again.

No breast is important enough to chance going down this road a second a time.

2. The current state of my body--you know, being one-breasted--is pretty unacceptable. It's a disaster. It really is.

When a man goes bald, and has some hair, that hair can still look good. The head can still look handsome. I do not look at my body and think, "Well, you've got one breast. . ."

It's like. . . It's like a hand of beautiful, long nails, painted perfectly. Except for the pointer finger. That one's missing its nail and there's a scar running across the nail bed instead. There's no looking at that hand and thinking, "Don't those 4 nails look nice?"

Not that I'm explaining anything to you all because I feel the need to. No, unless you're missing one or 2 breasts or are married to someone who is, your opinion on this matter does not count.

I think I'm writing it all down because my kids will read this one day. And because a year from now, I may want to know my own thinking as of October 2009.

In any case, as I say, the current state of affairs is not, I dearly hope, a permanent state of affairs.

So I look forward to reconstructive surgery, which I shall call henceforth "restorative" surgery.

And what, I ask, is the point of being restored on the right side to the age of 20 or so while still being 34 and post-nursing-2-babies on the left side? That would be disastrous in its own way, no?

I say: go for the matching set. Guarantee your life as breast cancer free.

Back to the question of "what's next?"--at some point after radiation, my body will start to heal. When we deem it strong enough, I'll have the left breast removed. I'm not sure if this can happen while I'm getting Herceptin, or how long after chemo I have to wait, so the timing is uncertain.

And then, at some point after that surgery, we'll meet with a plastic surgeon and learn about our options for restoration.

The road stretches long. . . I wonder if I will blog the whole time?. . .