Sunday, May 15, 2022

Surgery Tomorrow


 CW: medical procedures (ick)


Surgery on Monday

Today my husband and I are heading to Seattle for my surgery. On Monday I will be having a lumpectomy (remove the tumor in my breast) and a sentinel node biopsy. We are leaving the day be fore because we have to be at the hospital at 7am for the procedure that precedes the surgery. Then my surgery is in the afternoon and they want us to stay in Seattle Monday night, in case of complications, I think.


I wasn't sure if a mug with a port-a-cath would be gross to some people, so I tried this heart shaped almost-port on some mugs instead

The morning procedure will be a procedure to mark where the tumor is. If I had been going in the day before (or Friday), I would be getting a Savi Scout in my tumor. This is the same marker that they tried to place in my lymph node back in February (but they couldn't find the cancerous lymph node or the previous marker put in during my original biopsy in November). The Savi Scout marker would have been placed using a needle that kind of pops it into place. It makes a popping sound when they inject the marker (ick).


these port-a-cath bulbs have their first layer of underglaze in this photo and are in the kiln with their second right now 

Because I did not want to drive to Seattle on Friday and again on Monday, and because they don't do Savi Scout procedures on Sundays, they are instead doing a wire locator technique in the morning. My understanding is that they stick a wire through my skin into the lump and it sticks out. And that is the total sum of how much I am going to think about that one (ick!). 


Of course for me I also had to do a couple of port-a-cath mugs


Sean and I went to Seattle at the end of April for the consult with the surgeon for this surgery. Nothing much had changed from what we were told at the start of this process in November and December about what the surgery would be. Both surgeons (the one in Yakima and the one in SCCA) always recommended a lumpectomy and a sentinel node biopsy. 

I threw 25lbs of clay last week and trimmed the next day (and wore myself out!)

Lumpectomy 

The lumpectomy was recommended based on the size of the lump, which is now smaller than it was when first diagnosed. Basically if the tumor is small enough in relation to the size of the breast, they can do a lumpectomy instead of a mastectomy, meaning they take out just the lump instead of the whole breast. The research indicates that survival and recurrance rates are the same for both procedures, but the recovery time is better for a lumpectomy. 

port-a-cath bulb after the first underglaze layers

The only variable back in November/December, was the result of my genetic testing. Had I tested positive for genes known to be linked to breast cancer, they might have wanted to take out more tissue to reduce my risk of more cancer developing. But, as I don't have that gene mutation, my risk remains low.

port and heart mugs in progress

Sentinel Node Biopsy

The sentinel node biopsy is done when there has been cancer in the lymph node or nodes. We know, based on the original biopsy, that I had cancer in at least one lymph node. That means that the cancer had spread from the original site to the nodes. These lymph nodes are all over the body and help drain stuff, like if you have a bruise, they'll drain away the blood that collects outside your vasular system in that area. During the pandemic, we learned that they also help drain away stuff that happens because of getting a vaccination. That's why your lymph nodes might swell after a shot; your body reacts to the shot and then that stuff gets drained away. My use of "stuff" here is a strategic attempt to make this medical jargon accessible and not a total lack of knowledge of the right terminology (right? yeah, totally, lol).

partway through the first layer of underglaze

During surgery, they will inject some dye (radioactive or blue or maybe both) into my breast. The dye will drain, like it is supposed to, through the lymph system into the lymph nodes. The dye won't go to all nodes (at least not immediately), meaning that only some nodes are the place that dye (or any cancer bits) goes to first. So they will remove only those first level nodes.  The doctor said that she will probably remove about 3 nodes. 

new bulbs, only 3 with port-a-caths (because sometimes that's too much work)

Checking for Clean Margins & Cancer in Nodes

After my surgery, sometime in the next week, the pathologist will check my nodes and the lump for cancer. With the lump, they will want to check that they have clean margins, meaning that they got all the cancer and didn't cut through the edge of the cancer. If they cut throught the edge of the cancer, if there's any bit of the lump that doesn't have a boundary of non-cancer cells, they'll need to go back in for a second surgery to get that last bit (or risk having it grown into a new lump). The surgeon said that there is a 10-20% chance that they don't get the whole tumor and that she'd have to go back in for a second surgery because of this.

port-a-cath mug in progress

My nephew also had his cancer tumor removed and they got clean margins the first time. Obviously we're hoping that I have the same results. The fact that, when last measured, the tumor was 12mm on the longest dimension, down from 45mm in December, seems like it should help make it easier to get good margins. Also the fact that we're doing this surgery in Seattle with someone whose whole job is breast cancer surgery seems like it helps our odds.

layered ports with glaze and underglaze

With the lymph nodes, the pathologist will chop up the nodes and check for any cancer. The hope here is that there is not even a trace of cancer. If they find any cancer, they will need to go back and take out more nodes. There is a 75% chance that someone who had cancer in the lymph nodes at one point will still have some cancer. If that is the case, they'll have to do a second lymph node surgery, this time called an axillary node dissection, where they remove most of the lymph nodes under the arm. They want to try to avoid this because of taking out so many lymph nodes increases the risk of lymphedema or arm swelling throughout my lifetime.

heart mugs in progress

Axillary Node Dissection

If they do need to do the axillary node dissection, that risk of lymphedema is 20-30% and I would need to take a variety of precautions (pretty much for my whole life) to prevent that from happening. As a fairly active person, both professionally and personally, this seems like a risk I wouldn't want to have to live with. I'd basically want to prevent bruising or other kinds of damage that would impact the lymph system.

heart-a-cath bulbs

My surgeon recommended that if I need an axillary node biopsy, I may also want to have a second procedure with a plastic surgeon to reconnect and reroute the lymph channels. This surgery would reduce my lymphedema risk to just 5%. The catch? Apparently it isn't covered by insurance. But it sounds like it is totally worth it. And I may yet be in the 25% that doesn't have to do the axillary dissection at all.

spiky port bulb

The odds of 75% look bad, but I already have some good indicators (they couldn't find the cancer in the nodes using ultrasound in February and they couldn't find the cancer in the nodes using MRI in April). 

wiggly tubes (hope they don't break)

Results of Surgery & Next Steps

We won't know the "results" of my surgery for about 5 days after the surgery. I am scheduled for a post-op follow up with the surgeon on May 26, but we don't know if a possible second surgery would be scheduled before or after that visit. I am hoping to ask tomorrow before the surgery.

I threw, trimmed, handled, and decorated just 8 mugs and was exhausted afterwards, but I wanted to get them done in between chemo and surgery (before I have restrictions on my arm)

They will also be taking out my port-a-cath, so I plan to ask if I can keep that (for art purposes, of course). Though another art person I know recently told me that she wasn't allowed to keep hers.

My finishing chemo present to myself was an unrestricted trip to Inklings!

Family

My folks are in town this week. We hadn't seen then since September, before my diagnosis, because we didn't travel over Christmas, opting instead to start chemo. They ended up spend a lot of time in New Hampshire over the winter helping with my brother's family while they dealt with my younger nephew's cancer and treatments. As my nephew is going better (and other family is helping out now), they were able to get to Washington. 

my incredible daughter made a colorful port-a-cath necklace for me for Mother's day because she is 100% incredible 

My folks are going to stay with my daughter while Sean and I are in Seattle. On the two days we went to Seattle in December, she stayed home alone both nights. While she is totally capable of staying home alone, and while we've had lots of generous offers that she can stay with friends in town, I think she'll feel a lot better staying at our house with her grandparents (and the cats, of course).

that necklack though!

In the last week a number of people have told me that I'm doing a good job or being brave or whatever. For me, it is funny, because I'm just doing what the doctors tell me to do. Knowing that my prognosis is that the cancer will be gone by the end of the month (if not tomorrow) makes it much easier for me to maintain a good mood and a cheerful outlook. Of course it helps a lot that the chemo is done and that the last 10ish weeks of chemo were relatively mild. 

bulbs after the first underglazing firing

My brother asked how I was feeling about surgery and I'm not nearly as scared of the after effects of surgery as I was before chemo. Also, after dealing with the last two doses of A/C chemo in January, I don't anticipate that this surgery could be worse. I won't feel good, but I've done that before.

another port-a-cath layered bulb (because I'm obsessed)

I've also been asked several times about how Alison is doing or feeling. She is enjoying track and has lots of projects going in school and at home. She's pretty excited about her grandparents being here, and, for the same reasons as the rest of us, doesn't appear to be very concerned about the cancer stuff. She knows that my prognosis is good. I just asked her how she feels about the surgery and she said that she was more worried before the first surgery (for the port). Now she knows that I came through that surgery (and Sean came through his the year before) just fine, so she's not particularly worried.


I took a (morbid?) before chemo picture like this and here's the post-chemo version. I'm doing fine ;-)


Thursday, April 28, 2022

DoVA, Clay Sale, New Work, Last Chemo & Preparing for Surgery

Department of Visual Arts Student & Faculty Exhibition

Back of the DoVA postcard featuring ceramic dragon by Eli Ortega


Next Tuesday, May 3 from 5-7 is the opening reception for the Department of Visual Arts Student and Faculty Exhibition. This show features work from students in Yakima Valley College's online and on-campus art and photography classes from the past year (or maybe two). This year's show includes lots of ceramics and photographpy, as well as drawing, painting, and design work.

front of the DoVA postcard, featuring photography by Hingry Mendez

The art program has had an intensely strange time since the last DoVA student exhibition at Larson Gallery. The Spring 2020 show was cancelled because of the pandemic. The Spring/Summer 2021 show was online, though some work was in the gallery, making it a bit of a hybrid show. This year's show is our first "regular" show since Spring 2019 and our first "regular" show in the new Larson Gallery.


my most recent work, AC Cactus, featured in the DoVA exhibition


I'm calling the show "regular" in quotation marks because it still doesn't feel quite normal. We've been moving our classes slowly back to campus, but I only taught on campus in fall. I've been on medical leave since January, so I feel unusually detached from the goings-on in the department. Additionally, both our drawing and painting instructor, John Bissonette, and our drawing and design instructor, Meghan Flynn have accepted full-time positions out of state and are no longer living in Yakima. Of the four full-time faculty who were teaching for YVC in Fall, only our Photograph instructor, Chris Otten, is still working full-time for YVC this Spring (though I plan to be back in Fall).

New Work

I like how this sculpture looks different from different angles


I finished a couple of sculptures this week. The one I have at Larson Gallery for the student show was started and finished during my chemo treatment. I started building it in January, while I was doing the AC infusions. I glazed and fired it during the taxol infusions and finished putting it together before my 12th and final Taxol infusion. This sculpture isn't about cancer or chemo, like some the work I started building since, but it feels chemo-y to me because of when I worked on it.

thought not all the angles work as well as each other


This sculpture is actually based on the form of an old sculpture (now broken) from college. This version is much smaller, brighter, and with a very different surface, but when I built it I wanted to revisit the old form or shape of the broken sculpture. 

I used another sculpture in progress to hold up this one as the epoxy set.

I knocked off the top section while building this sculptuure and decided it would be stronger if I didn't try to reattach the wet clay at that stage. Instead, I kept the sculpture in two pieces until after glazing and firing. This week I joined the two together using epoxy.


This sculpture was fun to build, to show some techniques for moving the weight of the sculpture out away from it's starting point, but I'm not sure I'm as happy with the finished effect.


I also finished glazing and firing a second sculpture. This one I started building back around June of 2021 when I made a series of time lapse videos of my could building process to use in my clay classes (you can check out those videos at the link). I have more work waiting to be glazed, fired and finished, including a whole bunch of port-a-cath bulbs.

a plethora of port-a-cath bulbs getting their first underglaze coats


Clay Sale

The Spring clay sale was yesterday, April 28, from 11-6 outside of the Palmer Martin building (20). The date for the sale had to be moved up because of YVC's computer system transition to CTCLink that will be happening in May. I lost track of the sale a bit because I am not teaching this quarter. I also couldn't attend yesterday because I was in Seattle getting an MRI and meeting with my surgeon.  I'm looking forward to being there for our next sale in the Fall.


clay sale poster for Spring 2022


Last Chemo & Preparing for Surgery

My last chemo infusion was this past Wednesday! I am very happy to be done and I'm very ready for feeling good next week and having an immune system I don't need to worry about for a while. I was surprised that both my oncology nurse and my surgeon said that I should be basically done being immune compromised as soon as next week, though my nurse reminded me that I can still catch COVID the same as anyone else.
My friend Kelly took me to my last chemo appointment, which made it more enjoyable


Yesterday's MRI showed significant decrease in my tumor size. In December, my last MRI showed the largest dimension of the tumor was 45 mm. That's a bit larger than a golf ball (I just looked it up, the diameter of a golf ball is 42.67mm). Now the largest dimension is just 12 mm, a bit smaller than the length of a peanut (because I had a peanut handy). The MRI also showed no visual evidence of cancer in my lymph nodes.

a peanut, measuring about 15mm, and a bottle of peppermint measuring about 45mm

After the MRI, I met with my surgeon who couldn't feel my lump (we didn't have the MRI results yet at that time). We discussed the surgery plan and there's more to it and it will take more time than I realized. And disappointingly, it also isn't scheduled yet, I'm waiting for a call on that, hopefully today.

my studio assistant, thinking about drinking the glaze water


The surgery will still be outpatient, but they want me in Seattle the day before to place a Savi scout (the thing they tried and failed to put in my lymph node back in February). Then they want me to stay in Seattle the night after my surgery in case there are any complications. The surgery will have two parts. My surgeon will remove the lump with the Savi scout and hopefully get clear margins, meaning there's no cancer at the end of what they remove. She'll also do a sentinel node biopsy, squirting dye into the tumor to and letting it go to the lymph nodes. Whichever lymph nodes have the dye, she'll then remove those as well. She thinks it will probably be three nodes. 

My studio assistant, wondering why I never let her drink the glaze water

After the surgery, the lump and the lymph nodes will be tested to see if the lump has clear margins. If there is cancer at the edge of the lump, they'll need to do a second lumpectomy and take more out. They'll also check the lymph nodes. If they are all clear of cancer, I'm done with that step, but if any of the nodes have cancer, they'll have to do a second surgery and take out more nodes. Apparently just 25% of of the time the chemo gets the cancer totally out of the lymph nodes. That number looks bad for my chances of having a second operation, but I've got two things going for me. First, the tumor shrank a lot and second, they couldn't see cancer in the lymph node all the way back when I had an ultrasound in February. Unfortuantely, we just won't know if I'll need a second surgery (for either reason) until after the first one. In general, there's a 10-20% chance I'll need more surgery on the lump and 75% chance I'll need more nodes out. If I do need a second surgery, it will be a second trip to Seattle (I had originally thought they would be able to test the node and lump the same day and extend my surgery or get me back in the same day).

port-a-cath bulbs, first coat of underglaze


There's yet more possible bad news. If they have to take out a lot of lymph nodes, my chances of lymphedema (chronic swelling in my arm) will increase significantly, by 20-30%. The surgeon recommends, if we do have to take out more lymph nodes, that I have a plastic surgeon do a procedure to reroute my lymph system. This procedure is apparently not covered by insurance, but does reduce my chance of lymphedema down to 5%. We don't need to decide on that now, and I'm going to start by hoping that I'm one of the lucky 25% who don't need to have more lymph nodes out. 

blue port-a-cath bulbs, first coat

The other thing that surprised me about the surgery is the timeline. I had, for some reason, though we were talking about 4-6 weeks between the end of chemo and the surgery, but it looks like it can be just 2.5 weeks after chemo ends. I'm anxiously waiting for a call from the scheduler, because I want to do it as soon as possible. It seems like leaving it alone just allows it to start growing again. I feel fine enough. Though I was kind of looking forward to exercising and taking it easy (and enjoying flavor again soon, hopefully) through the month of May, if given the choice, I'm anxious to move on to the next stage.

port-a-heart bulbs, first coat

I had three appointments in Seattle yesterday, the MRI, the surgery consult with the doctor, and a meeting with the nurse to go over stuff I need to do before and after the surgery. Of course I need to stop eating at a certain point and get a COVID test, but I was a bit surprised how restricted I would be for a week or two after the surgery. I thought the restrictions would be similar to those I had during chemo (no heavy weights, walk but maybe don't run, etc), but apparently they want me doing even less after surgery, no weights, no lifting, the nurse even warned about not moving my arms too much while walking (shrug).

the only glazed port-a-cath bulb


I did get confirmation that I will need radiation and probably 6 weeks of it. We still don't totally know whether we'll do it in Yakima or Seattle. Sean is very concerned that Seattle will have better technology, but we haven't met with the Yakima radiation people yet. It sounds like another set of meetings we need to schedule for May. This brings May's grand total of cancer related doctor appointments up in the range of 6-10 depending on the results of the surgery and when my oncologist wants to see me again (after surgery).

Sunday, April 17, 2022

Loss of Taste & The Anticlimactic End Days of Chemo

Tongue Neuropathy

It is strange how distracting it can be to have lost most of one's sense of taste. This is my newest chemotherapy symptom and with any luck, it might be the last new symptom. I noticed that the taste of some foods, like M&Ms, changed early on in the treatment, but fairly suddenly a few weeks ago I started losing whole categories of taste, starting with the taste of meat.

I've been working on this sculpture for weeks and weeks.

As of right now, I can't taste meat or cheese; apples, milk and peanut butter taste funny; and lots of things just have far less flavor than they used to. I had a tuna sandwich with veggies from Subway and the whole thing tasted like water (the tuna, the cheese, the bread, the mayo, the salt and pepper, the tomatoes, the peppers). The only thing I could distinguish was the one lone onion (I didn't order onions). The other night I made twice baked potatoes. (I appear to be getting over my lactose intolerance, as I can handle cheese now, though I haven't yet tested it with ice cream.) The potato, cheese, and broccoli all tasted about the same. I pretty heavily salted the skin of the potato, but even so, I mostly distinguished texture rather than flavor. Even water tastes funny.

I'm having real trouble getting into the studio regularly enough to work on it, both because I don't always feel good and because of motivation

Tuesday, when I saw my oncologist (for the last time before treatment ends!), she said that it was probably neuropathy. Tongue Neuropathy, I did not know that was a thing. This makes sense, as my tongue has felt numb for a while. She recommended I chew on ice during my taxol infusion this week, which I did, but the symptoms don't seem to have improved. They may have gotten a bit worse.

I've now let it go long enough that I'm battling against the surface which is drying out on me between sessions.

My mouth feels dry and strange, so I try to have a snack, but then my mouth feels dry, strange, and has a funny taste. I tried some watermelon one morening and though it tasted ok when I ate it, the lingering flavor was strange, and didn't go well with the fuzzy numbness. The feeling makes me want to remove my tongue from my mouth, really, or maybe just find a way to bring moisture back. I did discover last night that pears are tasty and didn't leave a lingering funny taste or feeling. Of course the timing (how far away from treatment) might impact my results.

Around the top I planned to add enough catheter-like tubes to look like a whole separate texture, but as I added them when the work was drier than planned, I'm struggling with them a bit.

Just Two Infusions Left (but more blood draws)

I have now officially finished 10 Taxol infusions, for a grand total of 14 chemo infusions and 18 weeks of treatment. I have two more Taxol infusions and then my chemotherapy journey will be over (or, perhaps I should say a week or a few later, once all the symptoms fade, my journey will really be over). I am very, very, very, very ready to be done. I've been having a bit more nausea, and that plus the dry mouth/numbness/taste just makes me more and more anxious to have this part of the journey be over.


I haven't given up on the sculpture yet, but I'm less confident in this one than in most things I make.


Last week, during my blood draw, I was chatting with the nurse and said that I only had 2 more blood draws after this one. She responded by pointing out that I would have to continue to get blood draws after chemo ended. Party pooper, she is. Sean, my husband, thought I should have realized that I would still need blood draws, but it caught me by surprise. Apparently I'll have to check in with my oncologist every 3 months for a while (I forget what she said) and then every 6 months after that for a while. And she'll want to check my blood. Boo!

The surface looks really rough now, but I still kind of think I can bring it back.

I tried to ask if I could keep the port-a-cath in my chest (because blood draws out of the arm are icky), but she seemed to think I was asking for it to be removed. Understandably, I suppose I should want it out, but the port draws are less icky, in my experience, than the arm draws. I suppose a blood draw from the arm won't be as bad as having an IV in, but I don't relish the idea. Sean though I would get used to needles during this experience; I'm not sure I've progressed quite that far.

A couple of weeks ago, my friend Carli drove over from Olympia to take me to chemo. It was delightful to visit with her during the treatement. We had to wait longer than usual for the blood tests to clear me for chemo, which just gave us more time to chat. I can highly recommend having a friend you don't get to see often bring you to chemo.

Next: Surgery

I have an MRI and a meeting with my surgeon in Seattle scheduled for the end of the month. It is the day after my last chemo, which seems a bit strange to me, as that last infusion won't have had a chance to do it's job yet. At that meeting, or after it, we'll get my surgery scheduled. My notes from the conversation with the nurse navigator say that the surgery will be 4-6 weeks after chemo, though I don't remember that part of the conversation. My calculations, then, put the surgery in late May or the first half of June. The surgery will be an outpatient procedure in Seattle at Seattle Cancer Care Alliance (which is changing its name to Fred Hutch).

Last week I attended a Zoom meeting during chemo. This was the first time scheduling forced me to do this. It went ok, but it's a bit odd to have ones attention divided between what's happening the room and what's happening on the phone.


How I'm Feeling

I have been feeling pretty good over the last few weeks, much better than at the end of the A/C chemo. I've been noticing more of an upset stomach after chemo in the last few weeks and I finally did have to take some medicine for it, but it's still pretty mild compared to before. Going to bed early also seems to help.

My hair is growing back soft and white, but I'm really looking forward to the scar on my face (that's been there since at least January) finally healing. 
 

The other day I did a full grocery shopping trip in a store for the first time since December. I've been buying groceries via curbside pickup at Fred Meyer or letting my husband get the groceries, but they've been out of stuff or weird about bags and substitutions lately. I figured my blood work is good, COVID case counts are down, and if I went to the store early on a weekday, the store would be pretty empty. Well, apparently 9am on a Friday is prime grocery shopping time because the place was a lot busier than I anticipated, but I also felt like I was able to stay distant from folks pretty easily. The thing that surprised me was that I got winded putting the groceries on the belt to check out. 

Another view of this interminable sculpture

I've been walking every day and doing yoga and doing a modified workout on Mondays and Tuesdays when I'm feeling best, but I can tell I am still not where I was before the chemo, especially on Fridays and Saturdays when I tend to feel the nausea and fatigue. I'm hoping that my stamina will come back fairly quickly after chemo ends. I suppose I've got a month to get some of it back before surgery.

a heart shaped nearly port-a-cath bulb

I've also been noticing that my anxiety is cranked up a bit lately. I'm not teaching this quarter, which is a decision I made right about when I was feeling the worst. For the past month I've alternately felt like I could teach and like I'm glad I decided not to. Wednesdays would be tough because I have my chemo treatment, which takes a few hours, then I tend to feel groggy for a few hours (except for the day they gave me the anti-anxiety meds) and slightly nauseated or uncomfortable by the evening. Thursdays I tend to feel pretty great, but then Fridays and Saturdays (and lately Sundays) my tummy and my chest hurt and I feel uncomfortable and I get tired pretty easily.

a port-a-cath bulb with branching catheter tube

I try to schedule all of my tasks on Thurdays and Mondays and Tuesdays and give myself permission to rest, read, and nap on Wednesdays, Fridays, and Saturdays. I've noticed that if I make an effort to rest those days, I feel better by evening. I've also noticed that, even though food is less enjoyable lately with my reduced ability to distinguish flavor, I seem to do better if I eat certain foods with the aim of passing my weekly blood tests. 

my spinach smoothie look disgusting but taste fine

I've been drinking smoothies with spinach most days. The goal of the smoothie is to consume spinach, wheat germ, fruit, and water with the aim of staying hydrated and fighting anemia. I also have Dave's Killer bread (the kind with lots of seeds and nuts) every morning because that was recommended to help with the liver enzymes. Both of these measures have been generally better since I started adding these things to my diet. And as long as I can't distinguish flavor very well, it kinda doesn't matter what I make for breakfast. The good news is that fruit and vegetables so far have seemed to retain the most normal flavors.