Cancer: How Not to Say the Wrong Thing

^^^^ Me, in a slightly happier time.

I can’t take credit for this article. Someone else wrote it several years ago and a different person shared it with me, but it remains spot on.

“Ring theory” starts with the afflicted person in the center and then widens the base with each concentric circle. The idea is to comfort inward and complain outward.

Read it here.

A quote from the article:

“Remember, you can say whatever you want if you just wait until you’re talking to someone in a larger ring than yours.

And don’t worry. You’ll get your turn in the center ring. You can count on that.”

Cancer: How Did I Get Here?

Ok, I know this is not my best look.

Later I found out that I had a substantial dreadlock in the back of my head, adding insult to injury for the above photo.

I also took a moment to toss this on the way home from the hospital:

But let’s back up a bit.

December 10, 2018: Routine screening mammogram = Read as normal

December 18, 2019: Routine screening mammogram = Read as abnormal

The picture above was taken at Christmas 2019, when I knew the mammogram report wasn’t normal but I didn’t yet know why. I got a call a few days before Christmas that the radiologist needed to compare the recent images to old ones, then a call on December 26th that I would need to come in for more images and possibly a biopsy.

With the holidays in full swing, I had to wait until January 2nd. I would have gone the same day if I could have.

I returned to the radiology imaging center and for the first time, I learned that there were two areas of concern, one on the right and one on the left.

The technicians pointed out what they were observing. The left side showed a scattering of what looked like seven grains of salt – tiny calcifications – on an otherwise dark background.

The right was different. I could see that there was a larger area and it was right up against my chest wall. This scared me, both in size and location. It looked like it would be difficult to access and seemed like it could easily spread into the underlying muscle.

After about 45 minutes of additional images, I was advised that I would be getting an ultrasound of the worrisome area on the right.

The ultrasound technician started the scan on the right and immediately I could see it was a cyst. It was smooth, like a jelly bean, and had clear fluid within it. Although breast imaging is not my specialty, nearly 20 years of performing OBGYN ultrasounds has made me capable of identifying a cyst. I knew this was benign and that was a relief.

The left side was another story.

The small area of calcifications – those seven grains of salt – could signal cancer and I was advised that I should get a biopsy. I was offered to have it done on the spot or to make an appointment and return.

I wanted the answers now.

The biopsy was a more complicated process than I expected. There were parts that reminded me of doing an OBGYN procedure called a D&C, one I have done hundreds of times, where a thin tube with suction attached takes pieces of tissue and collects them in a small filtered container. The tissue pieces have to be X-rayed to ensure the calcifications are present in the sample (parallel to floating products to my OBGYN friends), and if the sample seems sufficient, a pressure dressing is applied.

And then you wait.

The radiologist who did the biopsy – and she was very lovely and professional; when she walked into the room I knew I was in good hands – called me the next afternoon and asked if I’d already received the report.

I had not.

Her message was very simple: “I’m sorry to tell you that this is an invasive cancer.”

I had to write it down. I didn’t trust myself to remember.

And then I had to hold it together to see a few more patients before I could go home and totally fall apart.

The next two weeks had a flurry of appointments: MRI, pre-op exam, meeting with a breast surgeon, meeting with a plastic surgeon, getting fitted for mastectomy garments (truly awful, and I hope you never have to wear them), etc.

The wait to surgery was excruciating. I spent my time walking on the treadmill at the gym every day for up to three hours, just to escape my brain. Even though I was told it wasn’t necessary, I stopped drinking all alcohol because it seemed like I could go to a melancholy place if I had it on board. I’ve never taken medications like Valium or Ambien so I also didn’t have these crutches. I only mention this because in general, I think I have pretty good coping skills and my career involves having difficult conversations every day, and if I was mightily struggling during this time, I don’t know how others do it. I hope that comes out the right way.

Because it seemed like the cancer was now just on the left side, I was offered a few options: a lumpectomy on the left PLUS several weeks of radiation to the remaining breast and armpit area, a mastectomy on the left or a bilateral mastectomy.

This is the point where I am obliged to say that every patient is different and everyone should make the choice that is right for their situation, but I knew that for me, nothing short of the double mastectomy would suffice.

One reason for this decision was due to recurrence risk: I was advised that if I did anything short of a double mastectomy, I would enter into a complex screening algorithm for surveillance of recurrence or a new breast cancer, and that my risk was 2% per year, or 50% over 25 years.

Another thing that everyone was very clear about: the type of surgery selected does not reduce the risk of dying from breast cancer. A double mastectomy will reduce future recurrence risk but will not save your life over a less aggressive approach. This is scary.

But here’s the real reason I chose what I did: Regret management.

I talk to patients about Regret Management All. The. Time.

Regret management is making a decision now to (hopefully) mitigate future feelings of not doing enough when the opportunity was there. In my work, it usually translates to patients trying IVF or continuing with ongoing fertility treatments before the proverbial clock runs out.

For me, I am far from feeling like I am done living, and I felt like I needed to do everything I could right now in the most aggressive way possible.

Although it felt like a million miles away, the surgery date eventually came: February 13th. I had an all female physician team: breast surgeon, plastic surgeon and anesthesiologist. Of course I loved this.

My overnight hospital stay was uneventful and I was home by noon the following day. I was told things went well, but the final pathology report is still pending and I will learn the stage and what comes next in the upcoming weeks.

^^^^ Also not my best look but I am home.

Early recovery has been … ok … I guess. The pain is more robust than I thought. I tried to avoid taking any prescription pain meds but woke up at 4 AM on Saturday in so much pain that I could not move. I had to rethink my decision for Ibuprofen-only.

Recovering from a mastectomy also has many limitations: you cannot raise your arms above your head, no lifting greater than 15 pounds, and there are two drains – one on each side – that are sewn into place but have to be cautiously avoided for tugging/pulling and must be emptied several times a day. This also translates to not being able to get a coffee mug down from the cupboard, washing your hair, driving, etc. It is strange to be so restricted.

The drains will remain in my sides until the output is low for two days straight. This usually takes a few weeks and means I am wearing my terrible mastectomy garments (which have convenient pockets for holding the drains) until then. I criticize them for their lack of fashion but they are really necessary and I am grateful for a friend who sent me one to wear. Having said that, I never want to see these again when this is all said and done.

A final comment: I had a nice sob in the middle of the night the first time I caught a glimpse of my body, which seemed very disfigured. Intellectually, I know this is far from the final product (I got temporary expanders placed in the OR), but the reality sunk in when I looked into the mirror. I am grateful for my skilled and artistic plastic surgeon, who is also a friend, and I know everything will turn out ok in the end but we are not there yet. The breast surgeon is new to me but also extremely cool, someone I could see myself being friends with, and she did an excellent job, too. I really hope the three of us can laugh over drinks sometime. My debt to these skilled women is huge.

For now, I continue to recover, physically and emotionally. I appreciate everyone’s kind words, friendship and support.

Now I’m Obsessed with Jenni Kayne

Tick off another mark on the List of Inevitability: Now I am obsessed with Jenni Kayne.

If you’re not familiar, Jenni Kayne is a high-end lifestyle brand that epitomizes effortless, natural California style.

From home goods to clothing to accessories, everything is Just So.

Just So Chic.

Just So Perfect.

Just So Simple.

Just So Stylish.

And Just So Expensive.

Cost was a factor that kept me away from Jenni Kayne until now. While I loved the curated offerings, even I could not justify a t-shirt for $125 (although I really, really like it).

And then things changed, like they often do.

For one, I received this amazing gift – really the most spectacular gift from the most spectacular person, and I will never discuss it here – that had so many beautiful Jenni Kayne items, including a bag, a pair of shearling slippers, a candle, and a fancy match striker among other luxuries.

I was so enamored of This Gift, which was Just So tasteful and lovely, and essentially I wanted to move into Jenni Kayne Headquarters and live out the rest of my days there.

Also, speaking of end of days, I have been vacillating between Why Bother and YOLO modes recently, and YOLO won out when it came to Jenni Kayne.

As I type, I am happily awaiting the arrival of my first real Jenni Kayne order, complete with moccasins, sandals and an oversized cashmere sweater.

I still have my eye on a lot more, and Dreaming of a Montecito Lifestyle a la Jenni is rapidly becoming a full-time occupation.

As a Patient: Before and After

Loss of control. 

Loss of dignity.

Fear.

Uncertainty.

Vulnerability. 

Being a patient can be excruciating.

Today it is my turn. 

Last month I was diagnosed with breast cancer.

Today I will undergo a bilateral mastectomy and hopefully begin the reconstruction and healing process.

I am not even close to a point of accepting this in a way that I see it as a lesson or gift, but I am here to learn.

What I am also ready to experience as a patient:

Perspective. 

Patience.

Understanding.

Grace.

Hope. 

If you are the type, I would welcome your best thoughts and prayers. 

P.S. The picture above is one I deliberately took before I learned of my cancer diagnosis. I knew the biopsy results would arrive that day, and I wanted to capture a moment that would embody Before, because I knew if the results came back as malignant, everything would be divided into Before and After. This was Before. Now is After.

When You Are A Muppet

Friends, this is was *almost* too hilarious to be true.

For my recent 47th (!!!) birthday, Spouse commissioned a custom Muppet, and boy, did the artists NAIL IT.

Because Muppet Jani is designed to look like Actual Jani, she is sporting a diamond ring, necklace and earrings, hot pink scrubs with her name on them, and lip gloss.

Love it! But I still need a lot of practice with my puppeteering skills.

Holiday 2019

Yesterday I finished the last bit of holiday shopping and wrapping.

Well, at least until today.

Trixie and I hit the mall(s) early Sunday morning to avoid the worst of the crowds. It was *mostly* successful.

I heard on TV that Saturday had been dubbed “Panic Saturday” for holiday shoppers and was expected to ring up more retail sales than Black Friday or Cyber Monday. If that was Saturday, I’m not sure what moniker Sunday earned – perhaps “Last Chance Sunday?” “It’s-This-Or-Walgreen’s-Sunday?”

Hard to say.

In theory, I love Christmas.

I love the music.

I love the lights.

I love shopping and selecting the perfect gifts.

I love the holiday candy and treats.

I love the decor – as long as it’s not littering my house until March.

But the reality is that there are many things about the holidays I DO NOT love.

The endless wrapping.

The paper and tape that run out with four packages to go.

The post office. THE POST OFFICE!

Tripping over Amazon boxes.

Breaking down those Amazon boxes and deflating those awful plastic packing bubbles.

The puzzle-cramming operation that is fitting everything into our vehicle.

Driving back and forth to various family members’ homes, where we invariably are late and don’t stay long enough.

No one is happy in the end.

Of course it’s too late to follow through on my threat to spend Christmas in Hawaii, but a girl can dream, right?

What will happen:

  • Christmas will come and go. Too quickly.
  • There will be moments of joy.
  • There will not be enough sleep.
  • There will be laughter.
  • There will be at least one Can-You-Believe-That-Happened moment that we have to process later.
  • There will be one unbelievable gift that Everyone will be talking about.
  • We will make memories.
  • Someday I will wish I could reverse time and do it all again.
  • We will still struggle to fit everything in our vehicle for the trip home.

Happy Holidays, Friends.

Family Pictures

After a several year hiatus, we’re sending out holiday cards.

And I have to say, our friends Scott and Kelly at Olive Juice Studios really knocked it out of the park, although all props go to Spouse for the concept.

But if you look closely at our “family” photos, you may notice one thing: I’m not in them.

Was I supposed to be?

Yes.

Did I want to be in them?

Also Yes.

Where was I?

Work.

Sometimes, there is no balance.

This may sound utterly counterintuitive, but it’s true.

One of the many reasons I went into medicine was autonomy, a way to (hopefully) have some say over how I spend my time.

I envisioned a schedule that included time for exercise, dog walking, occasional lunches or daytime coffees, kid driving, school activities, etc.

But at a certain level, the responsibility becomes so great that the balance is less. Every day, I am the following: a full-time physician in a busy, busy practice, a Kick A$$ Lady Boss to over 50 people, a Mom, a Spouse, a small business owner and a Person Who Generally Tries to Be a Decent Human Being.

And none of these take a day off.

Also true: Some days I do a better job at one or more of these than others.

I hope that these two get it, maybe not on the day these photos were taken, but thirty years from now I hope they can look back and realize I was doing the best I could.

XOXO.

Patagonia Better Sweater

Seriously, this Patagonia Better Sweater suddenly seems to be everywhere.

It’s not new but seems to be having a renaissance.

Made of recycled materials, the Better Sweater comes as a jacket (like mine, above, in Birch), 1/4 zip pullover, vest, hoodie, shirt jacket, hat or scarf.

Whew.

I can attest to the wearability and softness. The outer surface says “sweater” but the inside says “fleece.”

I had this on my Christmas list until I discovered an amazing Black Friday deal – roughly 1/2 price – and scooped it up early.

My Christmas List

This isn’t a gift guide in the sense that I am buying these for others, this is PURE ME.

Confession: I keep an ongoing wish list throughout the year, mostly to remember what I am into at the moment, sometimes to keep an eye out for deals and occasionally to share with others.

While the list includes the unrealistic (“Giant diamond ring” has been #1 for five years running), there are also the cool things I find along the way.

Here’s what’s on tap:

Image via Amazon

I *love* Cindy Sherman’s self portraits. A few years ago there was an exhaustive show of her work at the Walker Art Center in Minneapolis, and I spent hours immersed in her world. This new book is the #1 item on my Wish List.

Ok, I am also going to post about this tomorrow, but Santa came a bit early for me on this Patagonia Women’s Better Sweater. More thoughts coming, but suffice it to say this jacket – while not new by any means – seems to be having a renaissance in popularity. Include me on the fan list.

Image via Nordstrom.

Ok, here’s another item to file in the To-Me-From-Me category: These fluffy Ugg slippers. If I’m at home, I am always, always wearing slippers. Embarrassing but true: my second toes are longer than my big toes (this is called a Morton’s toe in medical terms), and the lifetime net result has been that I have broken my second toes over 4 times (!!!!) via a combination of running-related stress fractures or painful stubbing incidents. I’ve learned that slippers with some frontal barrier are enough to usually keep me out of trouble. These fit the bill.

Image via Jo Malone

It’s hard to pick a favorite Jo Malone fragrance, but there are a few that rise to the top for me. This isn’t one! However, I am well-stocked on my #1 winter scent (Pomegranate Noir, spicy and delicious for cold weather; FWIW, my overall top choice is Nectarine and Honey Blossom), and this one is a great alternative to round out a winter fragrance wardrobe. Did you know you needed a winter fragrance wardrobe? You do.

Image via Lululemon

Another future post coming, but 2019 was the year I went nuts buying Lululemon, a brand that previously did not appeal. What changed? I am not sure, but I went down a huge rabbit hole snapping up their running shorts, convertible Vinyasa scarves and workout jackets. This On The Go Poncho is slightly elevated from their usual fare. I want it.

Image via Lululemon

I promise to stop with Lululemon after this, but these gloves are So. Good. They are thin but do the trick to keep my hands warm enough from the time I get into my chilly car at the end of the day to when it warms up. Plus, they are thin enough to easily allow me to pick up my travel mug and sip coffee – an unusual requirement, but a requirement nonetheless.

Image via Crate and Barrel

This is the most needed, least exciting item on my Holiday List: new baking sheets. While we’re at it, pizza pans should also make the list. Despite how much I hate domestic chores, I frequently roast veggies of all varieties and heat more pizza than I care to admit. The grungy pans we have now could use an upgrade.

Image via Amazon

Described as the “Oracle with Attitude,” this deck of cards is meant to be a fun way to answer questions Magic Eight Ball-style, but with edge.

100% self-explanatory.

IRI Shoes

Love ’em or hate ’em?

These shoes kept coming across my Instagram feed, and I finally succumbed.

They’re from iRi NYC, a brand designed “to promote individual expression through footwear.”

I bought the exact pair above. They remind me of the Keith Haring Absolut Vodka ads from my youth. I was obsessed with those ads.’

The upper is neoprene and the chunky sole adds about 2″ of height.

I’m happy to report the comfort level is high and every time I wear them, people comment on how unique they are.

Mark my ballot as “Love.”