TOUGH TIDDIES: BREAST CANCER PART II

random cancer diagnosis or a genetic predisposition for more cancer(s).

This is when I first realized that I would be making decisions that would change the entire trajectory of my life.

I can’t even decide what I want to eat for lunch on most days.

In the moment, the genetics test was a no-brainer. I find information is power, and I guess I hoped it would give me the power to make those difficult decisions for myself with confidence.

I got the results back in a week. It felt like a month. At least long enough to hit a bargaining stage. I mean, cancer already felt like this ticking time bomb that I could not get out of my boob fast enough - did I really want to know if I could have more lying dormant just waiting to be triggered? Did I really want to be the one to tell my brother that his daughter could have a predisposition to cancer? Did I really want to have a child in the future if I knew they could have to go through this too?

Is this how every test was going to be?

For better or worse, my results came back with no genetic mutations. In other words, I have no genetic link to breast cancer based on the genes that are known at this time. I thought this was unusual. How else do people get cancer? Yet it has been the norm among the majority of young adults that I’ve met with breast cancer.

It really could happen to literally anyone.

It was 3 years ago that I found out the 2cm mass in my right breast was cancer (or “rubber ducky” as we lovingly called it on the outside). The weeks that followed are now a faint blur of tests and appointments flying by at uncontrollable speeds while simultaneously dragging along at an unbearably slow pace.

According to my biopsy, my ER & PR positive and HER2 negative breast cancer was most common and very treatable. It had not spread to the lymph nodes in my armpit, so I was still in the very early stages. A lumpectomy followed by radiation was all I needed (and I was happy to keep chemo out of the conversations!).

If I weren’t a young 31-years-old, all of this would all be somewhat “common.” But being in the 4% of young adults that get diagnosed with cancer is not common.

I guess I thought the beginning of cancer treatment entailed sitting behind a large desk in a doctor’s office, getting an outline of my diagnosis and treatment, and being sent on my merry way to chemo. Because

TV is real life.

And it’s not just me. Everyone wanted answers. I imagine it’s like someone sharing that they are pregnant and immediately being expected to know the name of their baby and the birthing plan. Except that my bundle of joy was an assassin.

Even when I started to have answers, no one understood what they meant. I could have told people I had stage 8N cancer with the Omegatron Mutation and probably would have gotten the same reactions.

We all wanted answers - we just didn’t know what that looked like.

It didn’t help that my diagnosis continued to evolve while I was sprinting into treatment. So many appointments. Hurry up and wait.

Apparently, there are dozens of gene mutations that are related to breast cancer. DOZENS. MULTIPLE dozens. While my family history had no indication that I had any of these gene mutations, there was one definitive way to find out if I was fighting a

On October 1, 2019, barely three weeks after getting the call with bad news, I was getting an MRI of my chest for a better picture of that little mass and to begin planning for my lumpectomy.

And my boob lit up like a Christmas tree. At least, that’s what I imagine a 5 x 3.6 x 4.6 cm mass with enough satellite lesions to get HBO looks like in an MRI. I also assume it’s what gave my other boob the gall to chime in with a new “problem spot” (that would have to be biopsied to diagnose).

When I was little, I used to wish for grapefruit-sized boobs. But my post-pubescent rack was nowhere near that size. I was really running out of salvageable breast tissue in this new boob-to-cancer ratio to reasonably consider a lumpectomy. The recommendation was a mastectomy.

I also had to decide what to do about this new problem spot in my left breast. Getting another biopsy made me want to cry. And if it was not cancerous, would I be forever worrying about it becoming cancerous? After discussing it with my sur- geon, I requested a bilateral mastectomy with the full support of my husband.

I prefer symmetry anyways.

Sidebar: The movies never seem to talk about lumpectomies or mastectomies, so I didn’t know what any of this stuff meant until my surgeon gently navigated me through the process. Basically, when we thought the cancer was smaller, the surgeon was going to take out her very professional ice cream scoop and scoop out the mass. That’s a lumpectomy. However, the mass was actually a fully grown crab with legs in my right breast, so the recommendation was that we remove all of the tissue from that breast to ensure we get every leg. That’s a mastectomy. Adding in the left breast made it a bilateral mastectomy. What about the nipples?

This was the farthest question from my mind, but apparently, nipples can be salvaged in a mastectomy. However, doing so in my right breast, where it was dangerously close to my cancer, put me at risk of having the cancer come back via my nipple. On top of that, it was unlikely I would have any feeling in my nipples after the surgery.

I really had great nipples. But they would be useless - except to potentially give me cancer again. So, I decided not to spare my nipples.

October 1 was the day I decided to fully remove my breasts and nipples from my body. My end goal was a quality of life for 30 more years, and I felt this was the best way to do that. I was fully supported by my surgeon, my oncologist, and my husband. It was terrifying and empowering at the same time. I chose to take control of an uncontrollable situation with my middle fingers in the air.

The world of breast cancer comes with a lot of surgery options. It was one thing to decide to take out my cancer’s breeding ground but another to live without breasts as a 31-year-old woman. I felt confident in all my decisions, but I knew at the end of it all that I would still want to feel like a woman in my own chest.

My surgeon empathized in a way that only someone with breasts could do and put a call in to a plastic surgeon in Seattle that specialized in breast cancer reconstruction. In the meantime, she spoke with my Oncologist, and they decided to put me on a drug that would block my estrogen receptors, fucking with my cancer’s food supply to buy me time to learn all my options.

Sidebar: The thing about ER & PR positive and HER2 negative breast cancer that makes it so great to treat is that we know it eats estrogen. I picture The Very Hungry Caterpillar eating its way through my estrogen-filled milk ducts as it gets fatter and fatter. However, if we can control the estrogen supply in my body, we can prevent the cancer from growing. This was critical, considering the cancer was fatter than we originally thought. And even though it’s been less than a month, everyone was working at rapid rates to get this cancer out of me in the most effective way possible while still trying to honor my own needs.

The estrogen receptor blocker was actually the first official treatment I received. I happily took the drug that made me a little woozy, in exchange for some time to learn about the incredible advancements in breast reconstruction.

I didn’t know this plastic surgeon very well, but he was patient in walking us through the different reconstruction options - and his work was beautiful. I had a lot of options, but I was a prime candidate for implants, and I could choose to have the bilateral mastectomy and reconstruction in the same surgery or delay reconstruction until after my bilateral mastectomy and treatment in Wenatchee.

As we drove over the pass to this appointment, I was convinced I wanted one surgery, and if that meant having both the mastectomy and reconstruction in one swoop then that was the option for me. But as we drove back home, I had a feeling in my gut that I just couldn’t ignore.

I told my husband I couldn’t reconcile what I was thinking with what I was feeling. I was sure I wanted one surgery, and while there were some risks involved with doing that before treatment, the surgeon was optimistic that it would go smoothly. It was the option I thought I wanted most. However, this plastic surgeon only did the reconstruction (not the bilateral mastectomy), so if I wanted to have one surgery, I would have to trade my surgeon in Wenatchee for a surgeon in Seattle that could do the surgery simultaneously with the plastic surgeon. People in Wenatchee will specifically seek Seattle doctors over Wenatchee doctors, so this wasn’t a terrible choice.

But it felt terrible to me. As far as I was concerned, I had the A-team of care teams. I loved my surgeon in Wenatchee - she was close to home, my only female doctor, my advocate, and worked closely with my whole team. I couldn’t imagine doing this without her.

My husband listened and kindly told me that it was okay to choose my gut. I would be in good hands either way, but I needed to feel comfortable. I had to give myself permission to let my heart take the reins on this one.

So, I chose to have a bilateral mastectomy in Wenatchee. Shortly thereafter, I would go to the plastic surgeon in Seattle for reconstruction. My middle fingers were back in the air.

In preparation for my bilateral mastectomy, I read every credible cancer website for facts and a handful of blogs for recommendations. I had a notebook of all the information I gathered and tracked every question regularly. I had a list of items that would help with my tubes, limited range of motion, and overall comfort. We borrowed a large, comfortable medical bed from friends, and another friend set up a meal train with a donation collection. My husband and parents planned to take time off from work for the overnight surgery and recovery from home. I set up taking time off from work followed by remote work for when I was ready. I was ready for surgery.

Up until this point, though, the only people that knew about my cancer were my family, work, and some friends. I wanted to personally tell the people I was closest to, but it was becoming difficult as word was starting to spread.

I never wanted to go Facebook official. I always saw it as an attention platform. But I was losing control of this spread of information, and I wanted people to hear it from me before the rumors. There was also a very public meal train set up, and it was chugging ahead whether I was conducting it or not.

Over several days, I drafted, waited, redrafted, deleted, then re-wrote a Facebook post to announce to the world that I had breast cancer.

I wanted to tell people I had cancer, but I recalled the number of people that immediately reacted with sadness - sometimes literal tears. I knew that sadness more than I ever felt comfortable sharing. But I wanted to change the narrative. I wanted people to react with optimism and hope when they heard of my diagnosis. I wanted them to feel like they could ask me questions without fear. I wanted to praise the care team that made it possible for me to feel all those things.

If I had the audacity to change the narrative on cancer, I was going all the way. One thing I feared about going public was the advice/opinions that came with it. It made it difficult for me to feel empowered to make my own decision when everyone else was trying to climb into my head. I just kept telling myself, “They just care so much about you that they want to help - yet they don’t know how.” It helped me to ap- preciate my loved ones while brushing off the advice and opinions that did not serve me.

So, I went to the heart of my own advice. If people just care so much and want to help (and how fucking lucky am I to have so many people care about me?!), then perhaps I could set them up for success by giving them constructive ways to help. I took the list of items I needed for surgery, along with my meal train/donation collector, and went public on Facebook.

I never wanted to go Facebook official - but I’m glad I did. The world chose to embrace my fight as its own, and I will never be able to thank my family, friends, and Wenatchee enough for that.

I’m not crying, you’re crying.

That’s right, middle fingers to the air doesn’t mean I didn’t have tears streaming down my face. Preparing for surgery made me sad - I was losing a beautiful part of my body.

Hate them or love them, if you had three weeks left with your breasts, what would you do?

For starters, I asked someone I trusted to take beautiful photos of the girls. I still haven’t decided if I want to burn or frame the photos, but I know I have them for the day I do decide.

One day, working in an office of women, a coworker asked me if she could feel my mass. At this point, I had to drive to Seattle to find someone that hadn’t touched my mass - why not let it serve as a “study aid” for other women? I remembered how I felt the first time I felt it, wondering if it was normal or not, and wishing I had any frame of reference. So, I pulled aside the top of my shirt and invited a line. I like to think my breasts dedicated themselves to breast cancer education before they left me.

While waiting in an exam room, I saw a list of advice from cancer survivors on the wall. One of the quotes was to celebrate the small things every day, and it stuck with me.

Within a week of my surgery, I celebrated my breasts in every way I could. I threw a boob-voyage party at the RadarStation, dawning one of the last wire bras I’ve ever worn. My dear friends got me a boob cake and passed out rubber duckies, encouraging everyone to take a photo with their rubber ducky on the day of my surgery. It was a day of laughter, smiles, hope, and breast cancer education.

I also took my boobs to a concert and jumped up and down a lot. I almost flashed a random person. I really wanted to at least. My husband drove me around town the night before my surgery to cross this last item off my list. In the end, I just couldn’t do it. I guess I wanted their last night to have some dignity.

Six weeks after being diagnosed with breast cancer, I was going in for surgery. They would remove the breast tissue from both sides along with 1-3 sentinel lymph nodes from both sides to confirm the cancer had in fact not spread to the lymph nodes. To do so, they would inject a bold blue dye into the edges of my areolas that would make its way to my lymph nodes, so the surgeon could easily find and remove the lymph nodes. It also turned my pee into gorgeous hues of blue.

Sidebar: We have hundreds of lymph nodes that act as a filtration system in our lymphatic system to help fight infection and disease. Once the cancer goes into the lymph nodes, it could be dumped and spread to other areas of the body. We were specifically looking at the lymph nodes around my armpit. Think of them like a pyramid, and the sentinel ones are the top 1-3.

It was an early morning that started in the spa-like breast imaging center. I knew what I was getting into this time. But as I waited, there was something I didn’t expect.

In the waiting room was another woman talking to a doctor from the breast imaging center. She was wanting more information on her recent biopsy, but the doctor had little information to offer except to recommend she wait and find out.

I left my parents and husband and went over to the crying woman, alone in a cold room. I hated being the kid invading her personal space and privacy, but I wanted her to know she was not alone. This woman was me just six weeks ago, but she was brave enough to come back and ask for more answers. I talked to her until she dried her tears, then I left and let her be. I don’t know what ever happened to this woman, but I think about her often.

On October 23, 2019, both of my breasts and 4 lymph nodes were removed from my body. After waking up from surgery, I cried.

But this was just the beginning of my fight.

Read Part III in December’s Comet.

Everyone’s cancer journey is different because every cancer, treatment, body, and circumstance is different. If you or someone you love is going through cancer, please do not take this as a roadmap to the cancer journey. If you have questions, talk to a doctor for medical advice. C