The Unveiling

Today was the first time that Dawn Ann got a good look at the mastectomy incision.

I tried to prepare her for it earlier in the day. We decided to keep in mind that this is not the final product. That this site is “Under Construction”.

Her own fears and feelings started to come through. She tried to tell me that this wasn’t fair to me. That I hadn’t bargained for this when we got married. She tried to tell me that I married a “woman”, and now she is losing her womanhood, piece by piece.

I countered that I didn’t marry a pair of breasts. I married a person. A person that I love dearly, with all my heart and soul. I placed my hand over her heart, and held her close.

When I married her, I loved her for the woman that she is. I still do. No surgery can change who she is, deep down inside. She is still my soul-mate, and the love of my life. This surgery helps preserve her life. I keep telling her that “We get to keep her!”, and that we look forward to having her with us for a very long time.

The time of the unveiling came later in the day, after the kids had gone to mutual. Even with our conversation earlier in the day, no amount of mental preparation can fully compensate for the shock when you see a large incision, instead of a breast. – Especially when it’s your own. It’s not pretty. It’s stark, and real and cold. Although the cancer is now gone, it has left destruction in its wake.

The plastic surgeon had cleared Dawn Ann to have a regular shower – provided that the stream of the shower doesn’t directly hit the incision or the drain tube sites. In order to take the shower, the bandages had to come off. I took the bandages off the incision myself. As Dawn Ann saw the incision for the first time in the bathroom mirror, there was a pale, scared look on her face. I could tell that she was grimacing, and trying to tough it out. I put my arm around her shoulder, and held her close. I asked her how she was doing. She managed to say something like, “It is, what it is”.

I know it was a real shock to her. We got her all showered, then put on a new dressing over the incision. The plastic surgeon gave us some cloth tape, that will be a little kinder on her skin. We put gauze over the incision, and over the drain tube exit points and taped everything in place. Then we got her dressed.

After a while, she got over the shock of seeing things as they really are for the first time. I gave her a big hug. I let her know that I love her, support her, and that I’ll be there for her no matter what. I must keep showing her this not by my words only, but in my actions as well.

I don’t know what else to do.

Plastic Surgeon Visit - 1 Week After Surgery

Today we visited the plastic surgeon. We discussed where we go from here in the reconstruction phase.

Right now, the immediate goal is to get the drain tubes out. It has been a week now since the surgery. In order for the drain tubes to come out, the doctor wants to see fluid levels of less than 30 cc’s for at least 3 days. At that point, a drain tube can be removed. Dawn Ann is not to that point yet. She is still having more than 30 cc’s per day of drainage in both drain tubes. This is important because the drain tubes cause a significant amount of discomfort.

We asked about when she could take a shower. The doctor told us that Dawn Ann could shower, as long as the water didn’t directly spray directly on the incision or drain tube sites.

We asked about how much she should be doing with her right arm. He said that Dawn Ann shouldn’t be doing much with that arm. No lifting of anything more than 3-5 pounds at this point. He reminded us that a full gallon jug of milk weights 8 pounds. So she is going to have to do things left-handed for awhile. After the drain tubes come out, then we can re-visit restrictions on activity.

We asked about driving. He said that driving would be fine, as long as she is not under the influence of narcotic pain killers. Right now, Dawn Ann is able to get through most of the day on over-the-counter pain relieves (Tylenol, and Ibuprofen). However, she still is taking a Lortab at night to help her sleep. So if she has not taken a Lortab during the day, she can drive Bryan to his ceramics class, which is at about noon time.

We asked about how much volume the tissue expander can hold. The doctor said that it could hold up to 800 cc’s. After Dawn Ann has had a chance to heal, the plastic surgeon will start injecting it with saline, through a little port that is along her rib cage. He said he typically would inject about 100 cc’s at a time. This would be repeated in two week intervals, until the tissue expander is just a little larger than the size of the eventual implant. Then he would let it rest for a few weeks, before removing the tissue expander, and inserting a silicone implant. The body would then close in around the silicone implant.

This process will take several months to complete. We will just need to take it one step at a time.

For now – let’s get those tubes out!

DCIS - In THREE Places!

Yesterday, while Dawn Ann was trying to get a shower, her bandage got wet, and began to peel away from her body. Since it was wet inside, we took off the dressing to keep the warm, moist, dark area under the dressing from being a breeding ground for bacteria.

We had to make a special trip to Walgreen’s to get some gauze bandages and tape. We put on some gauze strips and taped everything down. Dawn Ann’s post-mastectomy camisole, which gently squeezes things together, helped to hold the new dressing in place.

In the process of changing the bandages, I got my first look at the incision and the results of the mastectomy. I knew what was coming, but I have to admit it that it caught my breath for a moment. Obviously what once was there, was there no more.

There appeared to be some skin tucked into a fold for future use, possibly to cover the implant when that time comes. I tried my best to not show shock or surprise on my face as I re-wrapped her dressing. My shock was only for a moment.

She asked me if it was grotesque, or hard to look at. I told her it was all right. As of yet, she has not had the opportunity herself to see a full frontal view of the results of the surgery. She could only look down to see, without the aid of a mirror when we changed the dressings.

When Dawn Ann finally does behold everything for the first time, I want to be there for her.

Today we had our first follow-up visit with Dr. R (the breast surgeon) since the surgery. Dr. R peeked at the incision and stitches. The skin looked good, with no sign of infection. She just left our home made dressing in place. Tomorrow we will visit with the plastic surgeon. We will probably get a new dressing then.

Dr R. reviewed the final pathology report with us. Both sentinel lymph nodes came back clear of any metastases, as the preliminary tests had shown. The cancer has not spread into the lymphatic system. They identified both sites that were previously biopsied, and both of them were truly “In Situ” – which means that the cancer had remained in place, or localized. The cancer had not spread to any of the adjacent breast tissue.

The big surprise in the final pathology report was that there was a third cancer location found! It was in the upper, outside quadrant of the breast, and was found in a random tissue examination by the pathologist. This cancer was undetected by mammogram, sonogram, and MRI – and it was a very aggressive form of cancer too! Fortunately, it too was “In Situ”, or localized.

The finding of the third cancer spot re-confirms the decision to have a mastectomy. This third cancer spot was found by a random sample of the remaining breast tissue – after the known cancer sites had been examined. Who knows, if every section of the breast tissue had been examined there might have been yet more cancer found. The doctor confirmed that there was something about the right breast, know one knows why, that was causing the cancer to form. Even if we had done two lumpectomies now, sooner or later we would have needed to do a mastectomy as other cancer spots would eventually come to light.

Now we have to really watch the other breast carefully. Dr. R. wants to see Dawn Ann in 6 weeks for another follow-up to the surgery. From that point on, we will see her once every 6 months – forever. This will be to check the left breast, and to make sure that no further cancer occurs in any remaining breast tissue from the right side. Even with the mastectomy, there are still some microscopic particles of breast tissue that remain. In theory, (but not likely) it is possible that cancer could return in those remaining particles of breast tissue.

For now, we are glad that all of the cancer that we know of has been removed from Dawn Ann’s body. She will not need chemotherapy or radiation. The only remaining question is whether or not to have Dawn Ann start taking tamoxifen. Dr. R. recommended that we see a medical oncologist for further consultation. Tamoxifen is an anti-estrogen drug, that could potentially lessen the risk of cancer in the left breast. However, tamoxifen also has some serious side effects, including: blood clots, stroke, memory loss, vision changes and liver cancer.

Since Dawn Ann has had a hysterectomy, with ovary removal, there is not that much estrogen in her system to begin with. Right now Dawn Ann is leaning against taking tamoxifen.

Dr. R. presented Dawn Ann’s case to a “cancer board” last Thursday. Apparently there is peer review of cancer cases. Some doctors recommended that Dawn Ann take tamoxifen, and others were indifferent about it. All agree that chemo and radiation are not necessary at this time.

We will make an appointment with an oncologist, and make a final decision on tamoxifen after that consultation.

We also plan to meet with a genetics counselor in the next few weeks as well.

The Mastectomy Surgery

Dawn Ann's surgery was done earlier today. She is doing well, and resting comfortably right now.

The best news is that preliminary biopsies were taken on two lymph nodes, and they both came back free of cancer.

We won't know for sure if the cancer has spread, until we get the full pathology report, which should be sometime next week, we hope. If everything remains clear in the pathology report, we believe that the surgery alone will be the extent of the cancer treatment necessary. She should not need chemotherapy or radiation treatments, if all goes as we anticipate.

The breast surgeon said the surgery went really well. There were no unusual or unexpected findings in the tissue. No indication that the cancer was any more extensive than what we thought.

After the mastectomy was completed, the plastic surgeon came in to the operating room. He inserted a tissue expander under her chest muscle. Later, in about 4 weeks or so, he will begin inflating this tissue expander with saline solution. Every 2-3 weeks after that, he will add to the saline, until the spacing is large enough to insert an implant.

Post operatively, Dawn Ann has been doing pretty good. They have been using some pain medication, which is a very good thing. A little while ago, she was up and around a little bit, and she noticed that all of her pain meds from earlier in the day had worn off. Ouch! She has soreness in her chest, and her right arm. They gave her a half dose of morphine, and that helped her settle down.

Now (about 4:30 pm) she has drifted off to sleep for the first time today, since coming out of surgery.

We got off to an early start today. We woke up at 3:30 am. We had to be at the hospital by 5:30 am. It was about 7:15 y by the time they wheeled her into the OR, and I kissed her goodbye.

The breast surgeon came out at about 9:45 am to let me know how the mastectomy went.

By about 10:45, the plastic surgeon came out and told me that Dawn Ann's surgery was complete, and that she was going to the recovery room.

Dawn Ann now has a couple of drains that have been attached to her chest, and under her arm. We hope that they will be out by next week.

Well, this has certainly been an adventure. An unwanted, and unanticipated adventure, but an adventure nonetheless. I will remain here at the hospital tonight, until she goes to sleep for the night. Then I'll be back up here first thing in the morning, and I expect to bring her home sometime in the mid-morning time.

I must say that the hospital staff here at LDS hospital has been excellent! The doctors and nurses have been caring, compassionate, and professional. It is nice having a private room too. It makes it much quieter, than the 2-party room I had last year when I was in the hospital.

I also must say that we have had wonderful support from family and church members. My mother took our children overnight last night, and she will have them again tonight. She is also shuttling them about to school, and other classes. What a lifesaver. I don't know what we would have done without her.

Last Sunday evening we went over to mom and dad's house and gave blessings to Dawn Ann and to Amy. It seemed to help them calm down, and be comforted.

We also have received great support from the church. Our ward relief society president stopped by earlier this afternoon. The Stake President and his wife stopped by too. I serve on the high council in our stake, and it was comforting to see him. I was going to ask him to give me a blessing last Sunday, but I had to leave right after our council meeting for a speaking assignment. The rest of the day was busy with other meetings and assignments, and I just couldn't get back with President in time for a blessing. So today, I got a blessing from him, and I know it will help me in my role through this ordeal.

Thanks for all of your thoughts and prayers. We look forward to bringing Dawn Ann home tomorrow.

I have been writing this post off and on throughout the day. It’s now just a little after 9:00 pm, and she is settling down for the night. I think I'll tuck her in, and go home for the night.

The Drive

The alarm rang at 3:30 AM. We had an appointment to arrive at the hospital for Dawn Ann’s mastectomy at 5:30. We got ourselves ready and loaded our gear into the car.

We had a word of prayer together just before we left. We asked that the Lord would bless and sustain us through this ordeal. We asked for strength and comfort from the Lord. We asked that the hands of the surgeons may be guided as they operate on her. We prayed that all may go well with her recovery from the surgery. Finally, we prayed that the cancer may be removed from her body.

We listened to some quiet classical music and held hands as we drove to the hospital, which is about ½ hour away from our home.

As a husband, I had very mixed emotions as we made that drive. I couldn’t help feeling that I was taking her into harm’s way. What were they going to do to her? They were going to remove a member of her body. A very personal member of her body, that is so wrapped up in womanhood and femininity, and self image. Four years ago, she had a hysterectomy. After her initial cancer diagnosis, Dawn Ann expressed a fear that she was losing all of her “girl” parts. Now I was taking her in for a surgery that will remove one more of those "girl parts". Things will be different for her from now on, and that is something that we both will have to come to grips with.

Intellectually, I knew she needed the surgery. The cancer must be eliminated from her body. We couldn’t run the risk of having the cancer spread to other parts of her body, and threaten her life. We have to do this thing to save her life – even though it will cause much pain, discomfort, and many adjustments. It would be a huge mistake to not take cancer seriously.

Even knowing this, it is a different matter emotionally. There was a part of me that wanted to run the other way. As we approached downtown, we passed the Salt Lake International Airport. I mussed out loud for a moment that it sure would be nice to be turning into the airport to catch a flight to Hawaii, instead of going to the hospital. Dawn Ann agreed whole-heartedly with that idea!

We went to Hawaii for our honeymoon. Whenever we go through particularly hard times in our life together, we always recall “Turtle Beach”. Turtle Beach (our name for it) is on the island of Kauai. We spent the last evening of our honeymoon there. We rolled up our pant legs and dipped our feet into the water. We watched the waves roll in, and observed fish in the tidal pools. However our most pleasant memory of that time was watching the sunset over the ocean, and watching two sea turtles bob up and down in the waves just off shore. Hence the name: “Turtle Beach”.

We thought of Turtle Beach when the children were born, as Dawn Ann endured two C-Sections. We thought of Turtle Beach when she had her hysterectomy. We think of Turtle Beech whenever we need to picture something calm and peaceful in the face of something frightening, distressing, or painful. It has often times given us a few moments of respite, until we can collect ourselves and face whatever difficulty is before us at the time. Hence, my desire to take the “Turtle Beach Exit” at the airport, instead of proceeding on toward the hospital.

We reluctantly arrived at the hospital. Parking is always an issue there. Most of the on-street parking was already taken, but it was only for 2 hours maximum anyway. I knew I would be there much, much longer than two hours. Dawn Ann would be staying the night, but I would be going home sometime that evening, and returning the next morning to bring her home.

As we got out of the car, I opened the trunk and got the things out that we would be bringing in with us. Then we turned to look at each other. Spontaneously, and almost simultaneously, we both brought our right hands to a salute, in honor of the soon to be departed right breast. Whereupon, Dawn Ann and I began humming “Taps” -- in honor of the breast that would be gone when she would return home the next day.

We joined hands, and walked to the hospital entrance, to begin a new phase of our lives.