Archives for category: Facts

I’ve been remiss in communicating gracious appreciation for two events:

1) Nomination for the “Beautiful Blogger” Award from Chymeera. Thank you so much! I enjoy your blog and agree that your eyes really do “pop” in that recent photo you posted. Additionally, you are a lovely woman. If this is what you look like when you are going through cancer treatment, when you are feeling better, it’s going to be, “Dang, girl you look fabulous!”

beautifulbloggeraward

2) Recognition by the Empowered Doctor health news site as a “Top Cancer Blog“.  How cool is that? I know that some of my blog buddies out there have also been recognized the same way. Good for you! I thought it was a “pay us some money and we will advertise your blog” type thing but was pleased to learn that it is not. Forgive my initial cynicism but I get those kinds of calls in my business as a psychologist and they end up being telemarketing calls.

badge-breast-cancer

Finally, in the spirit of the “Beautiful Blogger Award”, which is given from one blogger to another, I would like to highlight a blog. There are many wonderful breast cancer blogs but I have up until now, yet to encounter a blog devoted to lymphedema.

Introducing Helen, who “lives in the land down under”. Helen just started the blog, My Lymph Node Transplant. She is a many year uterine cancer survivor. Part of her treatment included removing 22 lymph nodes, which resulted in continuing struggles with lymphedema. I was lucky (knock on wood) to only lose one lymph node as part of a sentinel node biopsy. I knew it could be bothersome and leave one more vulnerable to infection, but I had no idea how serious the condition could get until reading Helen’s blog. She not only describes her own life experience as she awaits her lymph node transplant (a new surgery) in a few days, but has also set up her blog as a treasure trove of clearly written educational information. Check out her blog!

I saw Dr. Welk yesterday for a marking appointment. He took a blue Sharpie marker and drew a surgical incision map on my torso. (Tip: Remove any skin creams or oils before the marking appointment, especially if you’ve had a full body massage a few hours before your appointment. Otherwise, Dr. W your plastic surgeon will get annoyed with you and you will have to go to the restroom and clean up your skin.) I must be special because I got way more markings than are shown on the illustration, below. He also explained the procedure to me.

Here’s the first picture of a pedicled TRAM procedure I’ve found online that actually makes sense to me. My surgery is a little different. First, the picture below is of immediate reconstruction. That means that an onco surgeon does the mastectomy followed by a plastic surgeon doing the TRAM surgery all during the same surgery. I am having delayed surgery. I had a mastectomy last August. Dr. Welk is also not using any skin from the TRAM flap in the reconstruction. He’s only using the fat from my abdomen and discarding the skin. I am keeping all of my breast skin. That was the whole point of his putting a tissue expander (temporary implant, which is gradually filled with saline over a number of months) under my skin. He was able to expand my skin to make up for what was lost during the previous breast surgeries. This was possible because I did not have radiation treatment and I had a full skin sparing mastectomy.

TRAM

Well, not exactly. My surgery on Monday will be at Swedish Hospital, founded by some Swedish-American physicians in 1908. Swedish Medical Center is pretty much a Seattle institution both literally and figuratively.

I asked John to stay with me in the hospital. He, being the wonderful hubby that he is, naturally said, “yes.” Then he added, “I’m looking forward to it. It will be like camping!”

Yes, like going on a camping trip and being mauled by a bear who rearranged my parts and hopefully supplies me with really awesome pain meds!

At least until May, that is. Yes, this means that I finished all of my assessment reports! Hoorah! I have also finished all of my sessions with patients until late April.

Hooray! Hooray!

Okay, I lied a little. I still have three progress notes to write and some insurance claims to sign.

Update: Now all of the paperwork is done! Yay!

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This post is from 7/31/12, the day of my first visit to a plastic surgery office. It was surreal.

This afternoon I met with Drew Welk, M.D. a plastic surgeon at the Polyclinic. We had a good meeting and it was interesting to shift from a physician who focuses on disease treatment to one who focuses on aesthetics. I found out that my incision is not in the best place to which I replied, “Yeah, my cancer insists on being all kinds of inconvenient.” To his credit, he laughed at my ribbing. I did learn that I have very favorable “breast geometry” with only a little post-partum loss of muscle tone. Yay, my breasts got complimented! They’ve been a little starved for positive comments lately, especially the right one, which is currently looks like a more than a  little like a dented tin can these days.

Dr. Welk is talking to Dr. Beatty tomorrow to share his input regarding the best way to make incisions for the mastectomy so that he has something reasonable to work with later after the fat has been removed from my skin, the latter of which I get to keep. He took pictures in the clinic photography booth, which was set up like the DMV, except for the fact that I was partially disrobed and he had his choice of three different expensive looking cameras. (Or maybe the other cameras belonged to other surgeons. That makes more sense.) He took the last picture after he’d drawn a little incision map with a Sharpie.

It wasn’t as bad as I thought it would be and I liked him. Plus it was a surgery day for him so between his energetic demeanor and the fact that he was wearing scrubs, he looked like a surgeon action figure. (Not to be confused with 1973’s surgeon Barbie and yes, she was real; click the link. Also, not to be confused with an action figure for the character, Surgeon from Hellraiser 2. Mom don’t go to that link: That surgeon doll is heinous.)

Okay, so Michelangelo is probably not the best sculptor to reference in this post. He was criticized for the way he sculpted breasts, basically that it looked like he’d thrown a couple of softballs on top of a suspiciously manly shaped torso. A better sculptor might be the 20th century artist, Lachaise. That man knew how to sculpt realistic breasts on refreshingly substantial looking women. Hmm. “The Lachaise of La Twins”? I’ll stick with Michelangelo for the alliteration. My cousin, Beth favors Bernini breasts herself. Bernini’s sculptures are absolutely breath taking but the first thing that comes to my mind is “the Rape of Persephone”–not the image I want in my head when thinking about my breast reconstruction. Beth conceded that Bernini tended to show women on the run.  But I present exhibits A, B, and C for your consideration:

One of Lachaise’s fabulous, “Standing Woman” I think this is a clear winner. Unlike “Dawn”, Lachaise’s sculptures of women actual look like a woman modeled for them. Also, Lachaise’s women look like they could fend off a Greek god or random creep in the bushes, unlike Bernini’s stunningly beautiful but nearly defenseless damsels.

Bernini’s Apollo and Daphne. This is Beth’s submission. In this case, Daphne is so desperate to get out of Apollo’s stalkeresque clutches that she turns herself into a tree!

Michelangelo. This is a sculpture I’ve seen in person. It’s from the Tomb of the Medici’s in Florence. This figure is supposed to be “Dawn” Looks like a man named “Don” with softball boobs, am I right?

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This post is from 7/18/12, the day of my second lumpectomy. I was already resting at home and had enough energy and adrenaline to write two posts! This is the second post. I have been very lucky to have such caring and competent medical care. Unfortunately, this surgery was not the end of cancer surgeries since the margins weren’t clear. I had multi-focal cancer, meaning that there were multiple tumors, which although tiny and relatively slow growing, were separate tumors. Consequently, I got another toe squeeze from Dr. Beatty after my mastectomy, which I would have three weeks after I wrote this post.

 

 

Surgery went well and I am resting at home. Dr. Beatty reassuringly squeezed my foot as he left after we had our pre-op talk. My first thought? “I have to tell my mom!”.

This is the email my mom sent to my last night after hearing about the clear PEM scan. (It still won’t make total sense so I’ll explain it later in the post.)

Hi Liz,
I was so relieved that I forgot to wish you well on the lumpectomy.
Hope all goes well. We love you so much.
All week I kept hoping that Dr. Clark would squeeze my foot
and tell me you’d be OK. I guess he did.
Okay, so here’s the explanation:
I was a preterm baby born with respiratory distress. My body was not yet producing sufficient surfactant, which allows lungs to inflate with air and keeps the air sacs in the lungs filled with air. Back then, physicians didn’t know how to treat it so the prognosis was more touch and go. JFK and Jacki Kennedy had lost a baby a couple of years previously from respiratory distress. (For years, all I knew about my rough start in life was that my lungs weren’t fully developed and that I had the thing that the Kennedy baby had.) To make a long story short, it wasn’t clear that I was going to survive. My mom’s OB/GYN, Dr. Clark was talking to her while she was in the hospital. I imagine that she was alone. She had 4 other children at the time so I am guessing my dad had them at home. Seeing that she was scared and tearing up, he squeezed her foot as he left the room. My mom has spoken of this event many times over the years so I know this little gesture meant a great deal her.
So when I told my mom about this she said, “You need to write about this in your blog!”
So hospital physicians out there, we like the foot squeeze. We give it two big toes up!

An explanation of benefits form arrived today from my insurance. It included the medical center’s fees for my medical oncology visit on 1/24. The total charges? $15,725, discounted to $8,628 via the contract with my insurance. This does not include the physician’s office charges. This is the medical center fee. I looked at the itemized list of services. The line, “Drugs—$14,365.00” caught my eye right away. The line above that read, “chemotherapy”.

Since I have not gotten chemotherapy, I assumed that someone else’s claim had been submitted with my name on it. Then I thought, “Wow, it could be the Lupron injection I get every three months.”

Being the Google Queen that I am, I searched “Lupron injection cost.” It looked like it costs several thousand dollars when used for other purposes. Even though the examples I saw were not for three month lupron to treat breast cancer, I thought the $15K was too high to be for the Lupron.

I called the medical center as well as my doctor’s office.

Lupron makes some extremely expensive hot flashes. I will be sure to put on a pair of fancier underwear on the day of my next injection.

I can imagine scenarios where it would truly cost that much money but wow, that’s a lot. What do people who don’t have insurance do? I already know what they do. They get substandard treatment and that’s just sad.

Just as in the commercials for Eggo waffles, someone keeps trying to take something that’s mine. That someone is cancer stress of course. Stress has taken my “ergo”. As I told my husband yesterday, my brain still holds facts (not as many as before) but what is a bigger loss is that I am so infrequently unable to integrate the facts into a conclusion.

Here’s a fictional example to illustrate my point:

“Hmm, I have a patient tomorrow from 1:30 to 2:30 in my office. I have another meeting at 2:30 at Random Elementary School. Since Random Elementary is not my office and I can’t be in two places at the same time, I need to reschedule one of my meetings.”

Here’s how it goes now:

“Hmm, I have a patient tomorrow from 1:30 to 2:30 in my office. I have another meeting at 2:30 at Random Elementary School. I wonder if I have any new email?”

Yes, fortunately, the above was a fictional example. I did not actually schedule myself this way. But I have a jumble of facts in my head at any one time and they are just noise when I can’t make meaning from them. I’ve made lots of other mistakes. With friends and family, I make a lot of comments along the lines of, “Oh yeah” but several minutes to days after I should have made the connection. A couple of weekends ago, my mom mentioned that she was going to go visit her friend at a rehab facility. I understood what she said. I was even aware that the rehab facility is not only in my city but about two miles from my house. I even understood that my parents live in another town. I like my parents. A few days later I told my mom, “Oh yeah, when you were visiting June, I should have invited you over for a visit afterwards.”

Yes, I should have but stupid cancer took my ergo.

L’eggo my ergo!

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George Lakoff

George Lakoff has retired as Distinguished Professor of Cognitive Science and Linguistics at the University of California at Berkeley. His newest book "The Neural Mind" is now available.

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