The best laid plans….

Writing my blog is a bit like therapy for me. So forgive me if this is long and boring.

Nearly a year ago, I signed up for the Carlsbad Marathon. I had run the half marathon version in 2013 and felt like by January 2014, I would be ready for my first full marathon.  I had a year to get ready, as well as plans for 3 more half marathons in 2013 and a handful of triathlons.  I figured Carlsbad would be a great first marathon for several reasons: It is literally next door; I'm very familiar with the course; it's fairly flat; and they had a pretty generous cut off time. 

I followed a 16 week training program from Runners Word Smart Coach. My mileage maxed out at 40 miles a week for a few weeks in December. I followed the rule of not increasing your mileage by more than 10% a week. I ran 4 days a week and cross trained with the bike and swim on the other 2 workout days. I ran increasingly longer "long runs."  They started at 10 miles, then went to 12, 14, 16, 18 and even 20 miles a couple of times.  Sure, I had to walk a bit on those long runs (I would run 4 miles, walk 1/4 mile). But I did it.  I was going to do 26.2. 

My last 20 miler was on December 23rd.  I ran the Carlsbad marathon course.  It went fine. Sure, the last couple miles were really hard. But that's the point, right?  In the middle of the night, I got up and as I walked to the bathroom, my left thigh protested. Okay, I figured it was just sore muscles.  

But sore muscles generally go away after a few days. This didn't. It was worse in the mornings and then would lessen, but not altogether disappear. I ran on Christmas Day and it was the worst run I've possibly ever had. It was hot. I was tired. I was dehydrated, and my dang leg hurt.   

I went and saw a sports physical therapist on Saturday. I actually had a half marathon that I was signed up for on December 29th. It was intended to be a "tune up" race for the next month's marathon.  The therapist was great-he told me that the muscle in question was my "sartorius." It's the longest muscle in the body, going diagonally from hip to inside of the knee.  He also pointed out that I had pretty tight hips on both sides, but particularly on the left side. So he showed me some stretches to do, most of which I already knew. But I realized that I need to do a LOT more stretching/foam rolling than I have been. 

The question was…do I run the half marathon? He thought I probably could if I warmed it up a lot.  Of course, I wanted to run it-I had some friends who were also doing it and it was going to be fun.  It was only 13.1 miles, after all. (Believe me, after training for 26.2, 13.1 isn't a big deal!) 

So I went for it. The leg hurt for 7 miles, but I focused on my form and running straight. After 7 miles it went away. I ended up with my fastest half marathon time yet…2:03 and change. I decided around mile 9 that I might even be able to break 2:00, so I went for it. 

I was REALLY sore for days after that. The course was a net downhill of 700 feet. I didn't realize the impact that has on those thigh muscles! Not just the sartorius, but my quads were not happy with me! 

I decided to take a week off of running. It was taper time anyway.  I figured that if I just cross train and give it time to heal, I would still be okay for the marathon. I even posted in the Runner's World marathon forum to have more experienced runners tell me that I would still be able to do it after taking a week off. They assured me that, "the hay is in the barn."  Okay. Great. I would swim and bike, with good warm ups, good stretches and ice after each workout. I also was taking Aleve twice a day. 

I had an excellent session with a skilled massage therapist who did some trigger point therapy on the muscle.  She went from insertion point to insertion point on the muscles of the back and hips and really dug in there to get some of the tension released. I believe she actually pinpointed the origin of my problem. My left hip was higher than my right hip. Going up the chain, the muscles on the left side and back were extremely tight, which pulled the hip up. That in turn caused that sartorious muscle to have to extend further when I would run. The prescription: keep even in my shoulders and hips. Interesting side note was that it was tightness around my left side where I had the invasive lymph node removal. Ah cancer! The gift that keeps on giving!

My run break ended last Friday when I did 5 miles around a local lake with the kids.  Well, they did a few laps and then played at the nearby park while I finished my run. I felt the leg, but it was okay. I did a lot of stretching and iced it and it didn't get worse.  I can do it if it just is like this or better, I figured. I re-read my "Big Book of Marathon Training" and got assurances that crises in confidence are very common during the taper. The hay was in the barn. Rest up and look forward. 

The next day my mom and I went to this fun event in Los Angeles for an upcoming TV series based on our favorite series of books, "Outlander." It involved standing in line for hours. No biggie. I figured it was an extra day off. But the next day, my leg ached. Uh oh. Instead of my planned run, I went for a swim. 

On Monday morning during my prayer time, I asked God to give me clarity in my decision making. I needed some guidance on what to do. Do I run through pain?  Would it get better in a few days? 

That day, in addition to everything else I was doing to treat the injury, I wrapped my thigh before the run. I did 5 miles and it wasn't that great. I was paranoid the whole time about my leg, and I did feel it the whole time. Monday night, my leg just ached.  I realized that God had answered my prayer. There was no way that I was going to be able to safely run/walk 26.2 miles on this leg in 6 days' time. 

So I've decided NOT to run the race. I know in my gut that it's the right thing to do, but a part of me is being resistant to the decision. So here is why I know its right:

• First and foremost, I don't want to injure it even worse. That would probably sideline me for months instead of weeks. 
• I've got things I want to do in 2014: A friend and I signed up for a 66 mile bike race in early March. It will be my first bike-only event. It has over 2,300 feet of elevation climb. I've got to be able to train for that.  I've also got a half marathon in mid-March, the San Diego Half Marathon. I had been hoping to break my 2:00 time barrier. I don't know if I'll be able to do that, but at least I'd like to run it!
• There are other races, even marathons.  I had pretty much decided that I would sign up for the San Diego Rock & Roll marathon in June, regardless of whether or not I ran Carlsbad. Deciding not to run Carlsbad sealed the deal. I signed up a few days ago. 
• The 450 miles I ran in training are not a loss. It increased my running fitness. It gave me the confidence to know that I CAN do it. I just can't do it injured.  It's funny when anything under 14 miles doesn't really seem "long" anymore. How twisted is that?! 
• I can keep my cardio fitness up while I nurse this injury through the bike and swim. Besides, I need to be doing more on the bike anyway with this race coming up. 
• I am an athlete, and injuries are part of the sport.  I was reading in one of my magazines (I think it was "Triathlete") and they were interviewing an elite athlete who pointed out that injury is part of the sport. So is rehabbing and being smart about what you do. If elites go through this, I guess its okay if I do. I mean…look at Ryan Hall. I'm in good company.
• Next time around, I can make changes that will hopefully avoid injury. First and foremost, I will do more weight training to strengthen my hips and glutes. And I will continue focusing on flexibility and myofascial release with the foam roller. Every day. I will also get regular massages to work the kinks out that I can't get myself. 

So that's it. I think I've got it all out.  I still plan on going to the Carlsbad race expo and picking up my shirt and other goodies. I did pay $70 after all. I'll feel a little "illegit" in wearing it, but it will be the most expensive running shirt in my collection! 

If you've read this far, I appreciate it.  I've accepted the disappointment, and am looking forward. Pray that my leg heals up so I can move forward as well. 

The last phase has arrived

Today as I was going into the radiation room, the tech reminded me that today was the last day of this kind of treatment. I think he said "protons" and that tomorrow we would start with "electrons." Or maybe it was the reverse. I have not taken the time to really learn about what they are doing to me. At some point, you've got to just trust that they know what they are doing, I suppose. He said that the next 5 treatments would be much faster than what I have been doing. Faster? It depends on your perspective. I thought the radiation treatments had been going pretty fast. It certainly beats 3 hours in the chemotherapy suite!

After the treatment, I got to see the doctor. Last week, he was a little impersonal I thought. This week was a bit different. At least he smiled and said hi as I came in the office. He took a look at my burns and said that it didn't actually look that bad. It certainly wasn't enough for him to give me a break. A break? No way, mister! The light at the end of the tunnel burns brighter each day. A break is the last think I want! He said that the last treatments would not be hitting that particularly bad patch under my arm. By the way, he said it was bad there because radiation does not like folds in the skin.

The blister under my arm has gotten bigger. It may have even popped, I'm not sure. After my shower today, it looked a little flat. You can't really see it in this picture, but its on the darkest part of the burn. The Mepliex pads are amazing. I am able to function normally with one on.  Even working out is doable. I took one off so Eric could take a picture, and it really bothered me. I'm going to get a fresh one tomorrow, because the one I have now is not going to last the weekend.

The very bright spot was my physical therapy appointment. We measured my arm and it didn't get bigger.  She thought I had definitely gotten over the allergic reaction flare up. I asked her to check how I measured back in September, before I actually had the lymphedema triggered. In many spots, I was significantly smaller.  ("Significant" = a change of .5 c.m. or more)  Any measurements that were larger were not significant.  Praise the Lord!  I'm not "cured" of lymphedema, it will be something I have to keep an eye on and treat accordingly. But it looks like I have learned how to live with it, and the radiation has not made me swell. Maybe it did swell, but I'm spending a solid hour working on my arm every day, and any daily swelling I've been able to take care of.

Week two in the can

I'm nearly 1/3 of the way done with radiation now.  Not quite, but almost. Today was my ninth treatment out of 33. Now I get 2 days off.  No Martin Luther King holiday for me.  That is just as well.  I want to get this finished, and a day off will just prolong the finish line.

So far, I'm doing pretty good. Compared to chemo, well, there really is no comparison. I'm still recovering from the physical effects of chemo, most notably in my finger and toe nails. They are still discolored and prone to lifting.  I've started wearing polish on my nails to cover it up. That makes me feel better about them, and they look nice too.  As for the radiation, I have not had any abnormal fatigue.  My skin has not yet shown signs of burning. I'm not expecting that to remain, however. The radiation oncologist said it usually shows up suddenly during week three. Lovely. Something to look forward to.  I'm doing what I can to keep my skin healthy now. As I'm in the dressing room right after treatment, I use an aloe based lotion. I don't need to warm the lotion in my hand before I put it on to avoid the cold shock...I'm numb in that area from the surgery! What a time saver! Later in the day, I apply a calendula lotion. I love this one, because its the same lotion (Weleda) that I used on my babies.  The smell takes me back to those early days when they were just days old and I would use the cream to do infant massage on them.  At night, I slather on the Aquafor right before bed.  I'm hopeful that this will help keep the burns manageable. 

The radiation office is a busy place.  I generally see the same patients there every day.  We don't talk to each other. At most, we give each other a sympathetic nod. I've taken to trying to guess what kind of cancer they might have. I'm the only bald one that I've seen so far.  At my appointment time, all the other patients are men.  When they come out of the radiation room fully clothed, I figure maybe a throat type of cancer. I have no idea what types of cancers are treatable with radiation. But it is something to pass the time.  Yesterday I was there early and the guy in front of me was in a dressing gown without his pants on. Yikes.  That can't be good. I heard him laughing with the techs as he went in, which was nice to hear.  Cancer sucks, so its good to try and laugh where and when you can. 

More problematic is my lymphedema. I went into the physical therapists yesterday and there was an increase of .5 cm on my lower arm (5 and 10 cms from my wrist).  The other spots we measure were all within the margin of "error" of my baseline measurements taken before radiation started.   My PT suggested I wear the bandages for a bit longer each day to address the swelling.  To the naked eye, you can't really tell when I hold up my arms.  But the measurements do not lie, and she re-checked them twice.  We don't want to let them creep up each week and then at the end of radiation have 2 centimeters to deal with. 

What a bandaged arm (not mine) looks like

I continue to get in two good sessions of manual drainage each day.  In total, this takes at least 45 minutes, sometimes 60 or more if I really work on it.  Last night, I bandaged and used some foam on my lower arm. I also kept the bandages on until about 9:30 a.m. today.  Usually I take it off when I get up at 6 a.m.  I'll experiment with wearing it longer this next week and we'll see what kind of effect it has on next week's measurements.  I don't mind wearing the bandages at night-I'm sleeping anyway. But they are bulky and a pain during the day when I need to get things done. My hand and fingers are wrapped (unlike this photo, where the fingers are not wrapped). I'm not supposed to get the bandages wet.  How do you cook and clean up after 5 people that way?  It's not very easy.  If I have to go that far, I will.  During the times I'm not in bandages, I wear compression garments. This is an area where prayer is needed.  Radiation really does a number on your lymph nodes, even if they are healthy.  To already have an impaired system that is struggling to keep up makes it all the more difficult. I am very thankful that my PT has taught me techniques to manage it.  I feel like I am able to control it as best I can.  Of course, the other thing I've learned throughout this cancer journey is that I have absolutely NO control.  

I'm very thankful to my mom for everything she has done for me throughout this time.  Well, for the last 41 years too! Since my diagnosis, she has been amazing. During this radiation phase, she takes time each day to meet Jean-Marc and I at the radiation office and she hangs out with him while I'm in getting treatment. They sit in the van and read books together. Today I came out and they were reading a story about the Old Lady Who Swallowed a Fly. Jean-Marc looks forward to this time each morning as we leave the house. I don't know how I would be able to manage this without her help and support. All of you who know my mom know exactly what a gem she is.  Love you, mom!

Going in the right directions

It is a good day.  I'm moving forward in radiation therapy, downward in weight (slightly, but I'll take it), and downward in my arm/hand measurements. I feel like doing Jean-Marc's happy dance! If you don't know what that looks like, check out this video:

First of all, I finished the first week of radiation.  Sure, I was only nuked 4 of the 5 days.  But I had to drive to the medical office all 5 days.  A big part of this so far has been getting into this daily routine.  Juggling getting the kids to school on time, carpools, Jean-Marc's Wednesday "Moove & Groove" class, and my self-imposed exercise regimen makes it a little complicated.  As far as the radiation itself is concerned, there are  no problems to report.  I understand it will take a few weeks for my skin to react. Or not. Maybe it won't?  We can certainly pray for that, anyway!

I also was pleased at my own personal weigh-in this morning. I was down 2 pounds from last week.  I wasn't going to start counting calories until after radiation treatment, but decided it wouldn't hurt to be a little more mindful about what I'm putting in my mouth now.  Especially after weighing in at the doc's office on Monday.  Not that I really "count" that one-I think of the Friday number at home on my scale is "the" number.  Anyway, it was down 2 pounds and I'll take it. Aside from just feeling better and meeting a goal I set for myself, I've learned that reaching and maintaining an ideal weight is important in my lifetime battle with lymphedema.  "Battle" may be the wrong word, because there is no "winning" with lymphedema.  It is something that you learn to live with.  In any event, excess body fat impairs the flow of lymph fluid thorough the tissues and into the lymph vessels.  It is another motivator to drop another 10-15 as soon as I can.  

Finally, I had a pleasant surprise at my now-weekly physical therapy appointment this morning.  The measurements of my hand and arm looked good.  I did not swell anywhere! Praise God! My hand and wrist saw significant improvement--almost back to where I started from before the flare ups before Christmas.  My upper arm did not improve, but it didn't get bigger, either.  I had not been that careful about bandaging on my upper arm so it wasn't a surprise.  The bottom line is that it looks like my "program" of lymphedema self-care seems to be working.  I just need to keep an eye on my arm/hand to see if I start swelling as radiation progresses and adjust accordingly.  If can get through this only bandaging at night, I will be very happy.

Thank you all for your support and prayers. I appreciate them very much.  Keep them coming!

All that and a bag of chips

Snap!

Today we are trying a new treatment option for my lymphedema:  a "chip bag."

My physical therapist (PT)  measured my hand and arm at 5 centimeter intervals. The hand is looking better, although not measuring smaller.  There isn't any significant increased swelling in the arm, but there is some on the pinky side of my lower arm.  My upper arm actually went down a bit.  When we compared my measurements over the past couple months, the numbers were going up and down.  Definitely not stabilized. The chemo may have something to do with that.  I was glad to see that my Christmas hand flare-up has subsided.

When we went to wrap in bandages, my PT decided to make a couple of these "chip bags."  It is basically small pieces of cut up foam that we put into mesh fabric (the same fabric that is my base protective layer).  Then we wrapped the bag on my lower arm.  Because my hand was doing better, we decided to just bandage it without any foam or chip bag.  It will dimple my arm a bit, but hopefully break up the fluid and help it move.

As she was bandaging, my PT confirmed the conclusion that I had come to.  That this process if one of me learning how to read the signs and determine what it is my body needs to be treated with, and then be able to do it myself.  It is important to change it up, she said.  Lymphedema can adapt to the same wrap and methods.  So using a chip bag once in awhile, or foam another day, or if things look good, just the compression sleeve will be helpful.  She even said I could use a soft natural hair brush to use on my arm instead of my hands for the self-massage.  Just as an option to change things up a little and keep this disease on its toes. That is in addition to staying well hydrated, having extra special skin care/moisturizer, and avoiding cuts/scrapes/burns on that arm and hand.

I'm in learning mode.  I've ordered several books from Amazon about lymphedema.  My PT gave me a couple photocopies from her medical book with diagrams of the lymphatic system.  I was pleased to find out that there are some lymph nodes on the inside of the elbow.  Knowing that, I can direct the massage to that area from my hand/wrist area.  The human body has between 500-700 lymph nodes.  It's wild that just taking out 15 of them can wreak so much havoc.

It can be depressing as I realize that I have a chronic, non-curable disease.  (At least by human standards.)  That is how lymphedema is described.  It can be managed, but not cured.  Great.  I'm coming to terms with it, but still have some emotional swings.  So that is an area of prayer if anyone is wondering my prayer needs.  I need to stay positive and embrace the good things in life.  Not get bogged down in the heaviness of daily wrapping and other concerns that go along with lymphedema.

The next several weeks during radiation are going to be critical.  The radiation oncologist wants to treat my lymph node area, so there is a very good chance my arm will want to swell.  It's going to take a lot of care and babying of this arm and hand to try and manage it during this time and as my body heals from the radiation.

Steep learning curve

I've come to realize that I am on the beginning of  steep learning curve about myself.  More specifically, my left hand and arm.

I need to be aware of how everything will affect my body now.  For example, I've been reflecting on my hand swelling on Christmas.  Playing a simple child's game ended up with me getting my finger tweaked. As my therapist pointed out today, anyone would have a swollen finger after that.  It's just that I swell differently.  But it goes beyond the obvious.  Things I eat and drink can affect it too. Not too much salt, lots of water, limiting diuretic drinks like coffee. I need to use the arm, but not too much. Its going to be a fine line.  That part is a little hard for me, because I like to push myself physically.  Now, that can be detrimental when it comes to activity involving my left arm.  I need to learn to read the signs and know where that line is.

I'm also learning about how to treat myself. Eric and I are learning how to apply layers of bandaging and foam to treat swelling.  It is a pain.  Over the weekend  found some customized garments that were layered to do the same thing.  I asked my PT about it today.  She pointed out that doing your own bandaging gives you flexibility to address the swelling as it changes.  Good point.  There may be times when I only need to wrap my hand, other times, my whole arm.

I've been reflecting on my own reaction to this lymphedema.  It really has made me more upset than the cancer diagnosis.  Yet its not life threatening like the cancer was/is.  With the cancer, I was told up front that I was in for surgery, chemo and radiation.  Those things all had an end date.  I'm realizing that this lymphedema is a lifetime of watching and treating myself.  Keeping an eye on the size of my fingers, hand and arm. Comparing the left and the right.  If I'm going to engage in any "risky" activities (traveling, exercising, being in heat, etc), I need to take precautions.  It's not going to end.  It's my life.  So I'm coming to terms with that.   My physical therapist also mentioned that I not only have to be "kind" to my arm physically, but emotionally as well.  I need to accept this as part of who I am and not hate my arm and hand.  She mentioned another patient who had lymphedema in her legs and referred to them in the third person.  I can see how it would get to that point.  When I look down at my swollen hand, I get annoyed at this part of me that is turning against the team.  I need to accept this fact about myself and not detest my own body.

Another thing I'm realizing is that there are just some things that I cannot control.  I knew that about the cancer diagnosis as well.  But I was given a set of things to "do" to deal with this huge game changer that was put into my life.  I was warned about lymphedema, but was given a set of things to "do" to avoid it.  I did those things, and it happened anyway.  I think I've been trying to control too much.  In reality, something that I've known intellectually is true is being reinforced in a very real way.  I'M NOT IN CONTROL OF ANYTHING!  God is.  I'm weak and fragile.  He is strong.  I need to remember that and draw on His strength, and not try to rely on my own.  Because it won't cut it.  Not even close. Maybe He will deliver me from this trial.  Maybe He won't.  It's not for me to try to control.  I need to "let go and let God." In the meantime, I have a book full of promises that I can rely on and not freak out:

• God loves me and wants the very best for me.  He is there to give me strength and shelter from the storms of life.  He listens to me and hears my cries. I am not alone in this.
• He WILL work out all these things for my good.  And probably the good for other people too. 
• Regardless of my physical situation in this life, whether I have a recurrence or not, whether I am swollen on my left arm for all my earthly years to come, that this life is just a vapor.  It's a drop in the bucket when compared to eternity.  And because of Jesus' sacrifice on my behalf, I've been guaranteed eternal life in a body that will not be sick. Praise God!  

Doing better

Thank you all for indulging me in my pity party over the weekend.  It felt good to just barf it all out there on the blog.

I am doing okay.  As everyone is, I have been very busy. That is why I haven't updated in a couple days. Christmas is this weekend, and I am hosting local available family here on Christmas Eve for dinner.  Not only that, I've been going to see the physical therapist every day.  AND, its raining like crazy here in North County San Diego.  I've been going back and forth to Escondido, where my parents live, so they can watch the kids while I do my medical errands.  The older 2 kids spent Monday night over there with some of their cousins and had a great time. My youngest brother is home from the Army too, so I enjoyed the time I was able to spend over there in between my comings and goings.  This lymphedema is slightly inconvenient!

My physical therapist and I continue to work on my hand and arm.  Each person is different, so it takes time to see what works for you specifically.  She feels like she has figured out my arm. My hand, however, is temperamental.  She wrapped my arm/hand lighter yesterday, but my hand still was swollen.  There was improvement of .5 cm.  But still puffy when I took the bandages off.  Today, she wrapped it with a piece of foam on the back of my hand to see how that went.  It may be counterproductive if my hand wants less attention.  We'll see tomorrow the effect of the foam.  I'll take Eric to the appointment tomorrow to start to learn the bandaging technique.

I had my eyes examined today.  After round 5 of chemo, I was worried about my eyes.  Not only were they watering, but they were oozing and crusty. Yuck.  The good news today is that my eyes are healthy!  Thank you Jesus for that.  My contact lens prescription hasn't changed, so that was good.  The watering eyes is common with chemo.  It's the body's way of trying to combat the dryness, she said.  It makes tears, but that doesn't really moisturize the eyes.  Kind of like putting water on dry skin...it can actually dry them more. She gave me an OTC eye drop to try.  As for the twitching eyes/eyelids....that is stress.  Who me, stressed?  Imagine that!  Who would have thunk it?

Anyway, I'm doing better. I feel like the other swelling in my body is going down.  This week is week 3 post-chemo, and unlike the last 18 weeks, I don't have to go in to get blasted with more chemo drugs on Friday.  It's time to recover and get stronger.  More white blood cells every day.  I'm still frustrated about my hand, but there is some purpose in it that God has.  I have no idea what it could be right now.  But I cling to Romans 8:28:  God will work ALL things out for my good.  I trust that.  Please continue the prayers for the swelling to go down.  That would be an awesome Christmas gift from above!

Mixed news

I went in for my second physical therapy appointment in as many days. We took off the layers of bandage to see how my arm and hand looked. To me, they looked puffy and wrinkly. But being taped up will do a little of that. We measured my hand, wrist and arm in various places and compared them. My hand measured smaller than yesterday by .5 c.m. Yeah! That is good news. My lower arm was still the same. Bummer. Looking at all of my measurements since September, there is a definite upward trend, which is not good. The bottom line is that I need to learn how to do the bandaging, get some of my own and monitor my arm and hand for the rest of my life.When it gets big, its time to wrap it up.  I'll always need to be careful of changes in elevation, travel and other things that may trigger swelling.

My therapist had me wash my arm in the bathroom and did another round of manual drainage.  She watched me doing some of it and said I was doing it right.  That was good to know. Then she re-wrapped my arm, using a different wrap technique.  I'll wear the wrap until tomorrow morning (Saturday).  Then I can take it off and wear my compression sleeve until Monday, taking it off at night.  Hopefully today's bandage will bring the swelling down and the compression sleeve will keep the size where it is until I see her on Monday.  I have appointments with her Monday, Tuesday and Wednesday for the next two weeks.  She wants me to bring Eric in so he can learn the wrapping technique so he can help me.  It's kind of difficult to bandage your own arm.  Even if it is the left arm.  Eric is out of the country until Tuesday night, so he'll come with me on Wednesday.

Todays wrap is more uncomfortable.  Even typing with my left hand is tiring.  I went to the gym after my appointment and couldn't hold onto the handle of the elliptical for very long.  For anyone thinking that exercising out with this is bad, its just the opposite. She said working out with the bandage on is one of the best things to do.  I'm supposed to use the arm as normally as possible.  But just moving is difficult.  I'm going to wear this bandage tonight as long as I can.  Hopefully I can stick it out until tomorrow morning.  If it gets too bad, she said I can take the top layer off.

The allergic reaction has caused swelling all over my body.  My mom said my face even looks a little swollen. I "weigh in" every Friday and the scale showed an increase of 3 pounds in one week.  I just know that is water and fluid retention.  There's no way I gained 3 pounds from pigging out and slacking off.  I need to get this fluid out.  My therapist recommended drinking lots of water.  I can do that.  If I can address the issue all over, it should help in my left arm as well.

The kids are out of school for Christmas vacation.  They are very happy to have 2 weeks off from school.  This fall has been hard for them.  They are doing great academically. I'm amazed at how well they've done in the face of my drama.  But it has been hard for them to hold it together.  It will be good for them to have some time off.  I need to try and downplay my lymphedema issues so they don't worry.  Besides, I'm ticked off at it to the point where I say, "Screw you, lymphedema! I'm going to live my life and enjoy doing it!"  I still have some Christmas shopping and errands to do.  Having so many therapy appointments will make that a little more difficult, but such is life.  At least mine right now.

My prayer request is for this swelling.  That the bandaging be effective to bring the swelling down.  Better yet, that God just heal my arm and hand of this condition.

Mummified

I had my physical therapy appointment today.  She measured my arm, hand and wrist.  This time, she's measuring in more frequent intervals so we can keep a closer eye on my swelling.  Just as I had feared, I had "significant" swelling-at least 2 c.m.  Aaarggh!

We started by doing a session of manual lymphatic drainage.  It really helps to have the therapist do it.  She can use 2 hands whereas I can only use 1.  I'm never really sure I'm using the right amount of pressure.  It has to stretch and release the skin, but shouldn't be too much pressure.  With her, I know its being done right.

Sporting my bandage

Then it was onto being bandaged.  Bandaging is supposed to make the swelling go down. It makes wearing my compression sleeve feel like wearing flannel pajamas. It is no less than 4 layers of bandage and padding.  It goes up to the first knuckle on my hand as well.  It takes a lot of effort just to bend my elbow.  I'm supposed to use my arm, though.  I asked if I could get it wet.  Nope. At least not from bathing or doing something like dishes.  But she said I could work out and sweat in it.  (Although that may be a problem if I can't really bathe!)  I had to work out today, though.  I missed yesterday with all of my errands and really need to get moving.

I also want to work out as planned just as my way of saying, "screw you cancer and lymphedema!"  It has interfered with my life so much, I don't want to let it take this away from me too.  As long as I don't do anything new, its okay. I even mentioned I planned to do a Jillian DVD and she said that was fine.  I was able to do it, take that lymphedema!   I also was able to bathe by filling the bathtub up with about 6 inches of water and using a washcloth and only using my right hand.  I put my left hand up against the wall to keep it out of the water.

I go in again tomorrow morning at 8 a.m. to have my arm re-checked.  They physical therapy department is making special accommodations to let my my therapist come in early to see me.  (Such a difference from the rude urgent care department that wouldn't even see me during their posted business hours!)  Hopefully, I will measure smaller and we can take this bandage off.  I don't know, it may take a week or more of wearing it. I'll probably be going in to see her next week as well.  We really want to address this pronto, especially before I start radiation in January.  A survivor sister told me that if lymphedma is caught within the first 3 months, its reversible. Hopefully my hyper-awareness will pay off and we can fix this.

I found out today that another mom in my daughter's class just found out she has breast cancer and is getting a double mastectomy.  I have other friends who are in the process of finding out if they have various cancers.  Is it just me, or does it seem like we have a cancer epidemic?  I've said it before, and I'll say it again.  I yearn for the day when there is no more sickness and no more tears and we are face to face with our Lord Jesus!

My prayer request is for my arm. That this swelling go down so I don't have to bandage myself up very long.  Pray also that my spirits stay up.  It would be very easy to let this depress me and get me down.  Being able to work out helped a lot.  But I can see this making it difficult to sleep, and I've been having a little bit of sleep problems this week already.

Swell!

And not in the good way, either.

I saw my physical therapist again today.  There was some slight swelling on my upper arm - about .7 cm. bigger than last time.  Great.  It wasn't a huge amount, but it is more than we would like.  Basically, lymph fluid is getting trapped and not flowing out of my lower arm area.  Just what we gals need--more "flab" on the underam.

I need to make sure to really work the area when I'm doing my lymph massage.  I also need to start monitoring the circumference of my arm and hand as well.  I won't be going back to physical therapy until after radiation starts, unless I start swelling more.

If I do swell more (usually more than 2 cm), then we have to use a bandage to wrap around the upper arm multiple times.  The compression sleeve I have now will not make the area smaller, but will keep it from swelling.  A bandage will make the area smaller.  Hopefully I won't have to go there. But I do need to wear the sleeve, especially when I'm exercising and during radiation.

We talked a lot about exercise and upper body strength work.  She made some good points, and I'm going to follow her advice and back off of the upper body work on circuits.  The main point was that my focus needs to be on getting through chemo and radiation.  Both of those "treatments" are rough on the body, destroying healthy  cells and tissue as well as the cancer.  While exercise is good, too much upper body work when my body is still recovering from surgery and adjuvant therapy can actually make me weaker in some ways.  That isn't to say I never will be able to do upper body again.  Just not while I'm in treatment for cancer.  Duh.  Slap me upside the head, okay?  I can still do cardio and circuits on the lower body.  But not much upper body, and certainly not with weights.

Got it.

On another note, I was in the mall today and saw the stores all decked out in Christmas decorations.  Any other year, it would have bugged me to see it all out this early.  Not this year--I actually liked it.  I can't help but identify the Christmas season as being "done" with chemotherapy.  Bring on the holly and deck the halls!  Fa-la-la-la-la, la-la-la-la!

Seriously, though.  Chemo is getting old.  I'm ready for it to be over.  I have 2 rounds left, so there is a light at the end of the tunnel. At first, I was excited to finally be doing it and getting on with treatment.  But I've done it. I've lost the hair, the whole nine yards. I'm ready for it to be over.  And Christmas for me, is a sign that it is getting close.

Midpoint

I am in the middle of this round of chemotherapy.  I am exactly half way through my chemo course of treatment.  Its hard to believe in some ways.  But in others, it seems to have taken a long time.  It is strange how the passage of time can seem so different. I just pray that the second half of chemo go as smoothly as the first half did. I have more energy and wellness than I ever imagined I would have, and I realize that it is truly a gift from God.  It is definitely supernatural, and not a product of anything from within me.

I had another physical therapy appointment today.  The good news is that my left arm has not gotten any bigger. That is an answer to prayer.  The bad news is that I wasn't doing the lymphatic massage quite correctly.  I need to knead the flesh rather than sliding my hand.  No harm done.  At least I've gotten into a routine with it.  Another recommendation the therapist made was to wear the compression sleeve and gauntlet several hours a day.  Not only to get used to it, but to make sure my arm doesn't get bigger.  If I wait to wear it until my arm gets bigger, I may not be able to get the sleeve on.  It is really tight, like tight thick pantyhose .  She especially wants me to wear it when I am going through radiation, since that is another risk factor for swelling.  I also should take measurements of my hand, wrist and arm a few times a week to monitor any swelling.  She said it is common for women to swell in the tricep area and not notice it for a long time, since you can't see your tricep as easily as you can the rest of your arm.

I still have that cording under my left arm.  She worked a bit on it, which hurt a little.  I just did the deep breathing like I did when I was in labor.  At least the cording has not limited my range of motion.  I've been very conscientious to stretch my arm and shoulder since my surgery in July.  It paid off.

I have been so blessed by everyone praying for me and supporting me. I have gone through a little bit of dry spell in my own devotional life, however. I had not been in the Word as I had before.  My prayers were on the run and not really focused.  With the kids starting school and needing to be out the door by 7:30 a.m. three days a week, it was easy to let it slide. A few days turned into a week, and I realized that the only time I was opening my Bible was on Sunday at church! It is wonderful to have everyone out there praying for me.  But I need to draw close to the Lord myself as well.  I feel like a bad kid.  Its not that God requires me to do read the Bible or pray to win His favor.  He is blessing my socks of whether I do it or not.  It's not based upon what I do (or don't do), but that is His nature.  It is more of my response to His blessing-I want to feel close to Him, and I had not been doing anything to draw near.

In church yesterday during worship I definitely got a tap on the shoulder from the Lord telling me to "Read My Word."  (His Word, the Bible, that is).   So this morning before the kids got up I enjoyed some time in the Psalms. Unless the Lord directs me elsewhere, I am just going to go through the Psalms and meditate upon them.  Here is one that really spoke to me this morning.  The italics are my own application:

 ¹ Hear me when I call, O God of my righteousness!
         You have relieved me in my distress;
         Have mercy on me, and hear my prayer.


I certainly need His mercy and for Him to hear my prayers.
       
 ² How long, O you sons of men,
         Will you turn my glory to shame?
         How long will you love worthlessness
         And seek falsehood?  Selah
 ³ But know that the LORD has set apart for Himself him who is godly;
         The LORD will hear when I call to Him.


The fervent prayers of the righteous man availeth much. (James 5:16)  I know that the Lord hears my prayers, not because I am so godly and righteous, but because I am covered with Christ's salvation. It is truly amazing that we have the ability to come before the God of creation with our cares and concerns.  What is man that You are mindful of him??  It boggles my mind!
      
 ⁴ Be angry, and do not sin.
         Meditate within your heart on your bed, and be still.  Selah  
I happened to be reading and meditating on this verse while still cozy in bed. 

 ⁵ Offer the sacrifices of righteousness,
         And put your trust in the LORD.

This trial has definitely made me walk the walk when it comes to trusting in the Lord.  It is so easy to give it lip service, but when you are faced with something like cancer, it can put your faith to the test. 
     
 ⁶ There are many who say,
         “Who will show us any good?”
         LORD, lift up the light of Your countenance upon us.
 ⁷ You have put gladness in my heart,
         More than in the season that their grain and wine increased.


I know that my positive attitude is another gift from the Lord. I should be freaking out, but I have a peace that passes understanding. 


 ⁸ I will both lie down in peace, and sleep;
         For You alone, O LORD, make me dwell in safety. (Psalm 4, New King James Version)

I had just enjoyed the first night of continuous sleep in several days.  Another gift!

After having started the day in the Word and in prayer, confessing my sins to the Lord, the day has been great.  I had a good power walk with my friends, found a new friend at my kids' school who is a sister in Christ, and just overall have had more patience and love in my heart.  I want to start every day the way I did this one.

My prayer requests:

• That I continue to be able to grow in my personal devotional life. That I do not let other concerns or activities get in the way of this special quiet time. 
• That the chemo drugs do their job, that my body continue to recover from the last round.  That I do not get sick from some other infection. 
• That my brother get home safe from Iraq. He is coming home later this month, but we aren't exactly sure when.  Travel mercies as he comes from Mosul (which used to be called Nineveh for you Jonah fans out there)

Winds through the stubble

I need to find another word for "weird" and "bizarre." I find myself using those adjectives way too much. But they pretty much are my life right now. They describe a new normal that I keep finding new aspects to.

I went outside (in the backyard) today without anything on my head for the first time. It wasn't for very long. In fact, covering my head completely slipped my mind. I just wanted to get Jean-Marc outside to kick some balls around. He loves doing that, and I needed to kill some time with him. If we were to stay in the house, he would start begging me, "eat, eat." It was a good hour before any reasonable dinnertime for him. So we went outside. (No worries about sun-it is a shady yard in the late afternoon).

I still have some stubble on my head, and to feel the breeze through it was...you guessed it! WEIRD!

I had a physical therapy appointment this afternoon. This was with a different therapist up here at the Kaiser facility in San Marcos. I was very happy to go, especially after the tingling arm scare this weekend. She started out by measuring my hand and arm to compare them with the measurements taken last month. They were a little bit bigger, but not by much. She wasn't really concerned about it. I just need to always keep a constant eye on my arm, wrist, hand and fingers to be on the lookout for any swelling. Especially since I wear my wedding rings on my left hand.

She went on to do some manual lymphatic drainage and described the technique as she did it on me. Its a very light touch. Calling it a "massage" is almost a misnomer. You start at your collarbone doing circular motions down and up. The idea is that you want to move the fluid away from the left armpit and towards the heart. From there, the heart can pass it to the kidneys and you basically urinate the bad stuff out. (Lovely, huh? Hey--your body does it too! It just doesn't need the help!) From the collarbone, you move down in the abdominal area, then to the hip crease/groin. Then diagonally down from the waistline to the groin, the left armpit to waist, then groin. That is the pathway that is most important-you want to show the body where to put that fluid on the left side...away from the armpit to the lymph nodes in the groin. After that, you move to the upper arm, elbow, forearm, wrist then fingers. Deep abdominal breathing helps move the fluid around as well. I'm supposed to do this 1 or 2 times a day.

She also worked on the cording on my left armpit. That was a little uncomfortable because it required her to really stretch the arm out and manipulate it around until the scar tissue would pop a little bit. I just focused on my breath and was fine. She said I had a really good range of motion and that the scar tissue looked really good everywhere. I'm glad to hear that, because it looks like a freak show to me.

I really liked this therapist a lot. She seems more low intervention than the one I saw before. She didn't think I needed a compression sleeve and gauntlet at this point. I told her I wanted to have one on hand in case the need did arise and she was fine putting in an order for two of them at the Women's Health boutique.

I asked her about using light hand weights to do some circuit training. I've been itching to get back to more upper body work. At this point, she said the weight of my own arm is enough of a challenge. (I thought...NOT!) Perhaps after all of my chemo and radiation I could start out with some very light weights. I'm just going to have to settle for getting exercise another way for awhile. I don't know if I'll ever be able to get back to the muscle tone in my arms that I had before the surgery. But at least I'm alive! Praise God for that and the strength that He has provided me.

I did some pilates this morning. Ouch. I'm going to be sore. I definitely need to do that more often. The core work is incomparable. This workout did a little bit of cardio which consisted of some ballet moves, which brought me back to my childhood doing demi-plies, grand plies, and eleves. The hardest part was the mat work on the floor for the abs. Oh. My. Gosh. It was killer. I was glad it was only 30 minutes! It was hard, but if I do it more, I'll be so strong in the middle. I think I'm going to go for it. My abs have gotten a bit soft since my surgery. I haven't gained any weight, per se. But considering I had all my breast tissue removed, I should have lost a few pounds through that. So I think I did put on a bit, even though the scale does not reveal it. I also went on a power walk with friends after we dropped the kids off at school. We didn't do the "big" hill, but it was enough to get the blood flowing.

I am definitely due for a long visit at the Women's Health Boutique. I need to get fitted for the compression sleeve, but also for post-mastectomy bras and foobies! (Foobies=prosthetic/fake breasts that slip inside a pocket in the bra.) I've been going without anything for a few weeks now. No bra, no camisole. It would be nice to have a more feminine form though sometimes. So bring on the foobs!

My prayer requests:

• That I do not develop lymphedema. I just don't want to go there. Having to wear really tight compression garments all the time, no way.
• That the chemo drugs are effective against any renegade cancer cells. Someone at church yesterday asked me if there was anything he could pray about for me. He has sat near me on and off for a few years. I don't think he's that involved in the fellowship-he drives down from LA a few times a month to visit his mom. I guess the scarf on the head didn't give it away, because when I said he could pray that the chemo does its job, he was shocked. It's good to know that wearing a scarf on your head for 2 weeks in a row doesn't flash 'CANCER PATIENT' in neon lights to the world.
• That the stubble on my head just fall out. The good news is that the sores on my head have stopped appearing and it isn't irritating as it was last week. Answer to prayer, right there! Thank you, faithful saints!

Tingling...should I be worried?

I think my left arm has been tingling on and off all day. I'm concerned that this may be a sign of lymphatic fluid buildup, or lymphedema. I don't notice any swelling. Just the cold and tingling feeling. Anyone out there who has experience with this...is this a sign of it?

Maybe I'm imagining it. You know when you focus on something, you can actually start to make it a reality.

I actually took today off from working out. The kids and I worked a little bit on picking up the house today. I'll fess up...I did do a little bit of spot vacuuming and mopping downstairs. I made the kids do it all upstairs, though! The post-operative instructions I got 8+ weeks ago said not to vacuum for 6 months. But it seems like such a small and simple task to do. After all, I'm able to do so much physically. Plus, I used my right arm most of the time. But maybe I did overdo it. I don't know.

I have a physical therapy appointment on Monday to begin to learn lymphatic massage. That will help me be able to move the fluid around. I am grateful to be going so I can have the therapist check me out, take measurements, and see if my wrist arm and hand have gotten any larger since my first appointment a few weeks ago. I also have the exercises the physical therapist gave me that I can do twice a day. I haven't been 100% faithful at doing them, although I did do them last night and this morning. You can bet I'll be doing them from now on.

My prayer requests:

• That this tingling feeling go away, that any and all lymph fluid that needs to drain from my left arm do so immediately.

Physical Therapy....Finally!

I had my long awaited appointment with a physical therapist today-nearly 6 weeks post op. I was interested in finding out from the therapist about my recovery from surgery and to see what activities I am "allowed" to do now. I also wanted to learn about how to avoid lymphedema.

The therapist was actually a lymphedema specialist. Lymphedema is an accumulation of lymphatic fluid in the interstitial tissue that causes swelling. It can develop when lymphatic vessels are missing or impaired (primary), or when lymph vessels are damaged or lymph nodes removed (secondary). In my case, it is secondary since all of the lymph nodes under my left arm were removed.

This condition, or the threat of it, is going to be something that I am on alert for throughout the rest of my life. A swelling of my left arm and hand can develop at any time.

She asked to see my scars, and offered to step out of the room so I could put on a gown. Don't bother! I'm not shy about my chest in front of medical types any more. I just stripped off my tank top and pulled my camisole down around my waist. Whatever. She said it looked "really good." Seriously? THAT is good? I told her it reminded me of Frankenstein. She suggested that I massage the scars to loosen up the tissue. That'll be easy since I'm rubbing Vitamin E oil on them twice a day anyway. She said that the looser the scars are, the better. Especially down the road when I am having radiation treatment.

The first thing she did was to measure my hands and arms at various places to find a baseline. No big deal, although it left little black sharpie marks on my arms. I had been concerned about a strange fibrous "band" under my left arm and showed her. No problem, she said. She had me lie down on my back and she pressed hard on each end of the band. It was a little uncomfortable. Then she had me move my arm up and down, like I was making a one-armed snow angel. She heard it go "pop, pop, pop" and then it was gone. I didn't hear the popping, but my head was on a pillow with a paper protective cover, so all I heard was the sound of the paper rustling. She said it was scar tissue in the lymph area, referred to as axillary "webbing." I found this interesting website about it. I think I'll bookmark it just in case it comes back. (It has pictures if you want to see what it looked like-I just don't have permission to repost them).

Because I have no lymph nodes under my arm, my lymph system is compromised. The lymph

system gets rid of "junk" in the body as well as filters out disease causing things. If you want a more scientific explanation, you can go here. The lymph fluid travels around the system in a particular order. You have lymph nodes in your neck, under arms and groin. The good news is that I can do some simple exercises every day to help move the fluid around. I also am going to go back and learn something called "lymphatic massage" that will also help the system work and thus avoid lymphedema.

I'm all about prevention, so I'll be faithful about the exercises and massage techniques.

We also talked about risk factors for lymphedema. Anything that would make me swell. It could be: hot weather; travel; changes in altitudes; cuts/scrapes or injuries on my left arm or hand; tight clothing; overheating; extreme temperature changes; my future radiation treatment; and more.

She suggested I get my doctor to prescribe a compression band and glove to wear. At first, she told me to wear it during my waking hours for 2 weeks. After that, just wear it during those high risk times, unless I actually do experience some swelling.

It's all about knowing my body and being aware of slight changes in it. That is where exercise comes in as well.

There is no "program" or list of exercises I can do. When I asked her that, she told me to stop thinking in that way. That is going to be tough. I'm used to printing out Jillian's workout and going down the list without exception. Give me a program, and I'll follow it to a "T" like a good girl.

There were some hand weights on the wall, so I asked her when I could start lifting weights again. She said I could now! Hallelujah! However, moderation is the key. Hmm. I've never been real good at that one. She said I could increase cardio workouts by 5 minutes every 3 workouts, and add 2 new upper body exercises every 3 workouts. Well, I told her I was already doing 60 minutes of cardio. Did I mess up? Nope! She said I just had that as a baseline. My baseline is going to be different from anyone else's, which is why there isn't a "program" out there. She said, (and I quote), "You are fit, Tonya." The key is going to be starting new things slowly, not overdoing it, and keeping an eagle eye on my left arm. If it starts to swell, I need to back off.

The other piece of good news is that she said I can pick up Jean-Marc. I'm a mom, she said, and you need to be able to pick up your child. But like the exercise, I need to keep an eye on my arm and make sure I don't swell. That is going to have to be a habit I develop for the rest of my life.

I made two of three follow up appointments so I can come back and learn the lymphatic massage technique. Fortunately, I'll be able to do those in San Marcos. (Today, I had to drive down to Kearny Mesa in rush hour traffic on the 15.)

My prayer requests:

• That I don't develop lymphedema!
• That I be able to ease back into some upper body exercises. Exercise is a sort of therapy for me, mentally as much as anything else. It has been hard to be restrained and unable to do as much. I still need to take it easy, and that is not easy for me.
• That I do not catch the cold that Olivier came down with. I've had a sore throat for a day or so. That is usually the first sign of a cold for me. I took my last Cipro this morning for this round. I'm hoping that, as well as a lot of fluids and frenetic hand washing will keep me from coming down with his cold.
• That the cancer cells are being disrupted and dying horrible little deaths inside my body. :-)

Thank you all for your continued support and prayers. I feel like Moses in Exodus 17 when he went up on the mountaintop to oversee the battle. As long as his arms were outstretched towards heaven the battle went well. But his arms got heavy, and it took Aaron and Hur to come alongside of him to help him hold up his arms so the battle could continue. Your prayers are like the aid of Aaron and Hur to me as I go through this. I thank God daily for all of my support system....YOU.

Getting physical

One week until chemo!

I noticed a strange thing under my left arm the other day while blow drying my hair. (No, its not a lump!) It is like a tight cord under my skin. I don't have it on my right side. It must have something to do with the lymph nodes having been taken out.

I have my first physical therapy appointment on Tuesday. I'm looking forward to talking with this person and finding out more about what my body can (and cannot) do. When I stretch my arms up to the ceiling, it feels like the left side is shorter, and that cord under my arm really pops out. I'm also looking forward to learning about self-massages that I can do to aid my body in lymph draining so I do not develop lymphedema.

I love getting massages. I always have. Really deep and hard ones. So much so that it sometimes hurts, you know? I don't know when I'll be able to have another one. At this point, it would just hurt on my arms and upper chest. But I don't know if the deep tissue massages are good for me now that my lymph system is compromised. I stumbled onto the concept of "oncology massage." I think I read about it in a comment to someone's blog yesterday. Anyway, there is a Society for Oncologic Massage. I browsed their lists of therapists and found one that nearby in Carlsbad. Of course, I'll ask my doctor first. But it would be nice to get a massage at some point. My friend who went through chemo not too long ago said her massage therapist would not do a massage while she was in chemo. Maybe there are special techniques that are okay?

This is a pre-op picture of me being silly. I had just worked out and was high on endorphins. That's my excuse for it. I kept it to remind myself of what I could do "before." If my body totally gets out of shape, I'll look at it to know I can get back again.

Mom and I continued our workout regimen this week. Monday, Wednesday and Friday we go to the gym and do a solid hour of cardio. I have a heart rate monitor that I like to wear to make sure I'm not slacking off. I try to get to a 400 calorie burn in an hour. For me, that is one intense hour at about 80-85% of my target heart rate. Then we stretch. The last two times, I've been able to do some lower ab work as well. As long as it doesn't pull on my chest, its okay. I have to be really careful

about form, which means...no cheating! On Tuesdays and Thursdays we walk. This week with my mother in law gone, we've taken all 3 kids to Discovery Lake and get them moving as well. They have the option of biking or walking. Jean-Marc has no choice-he's stroller bound! Walking alone gets kind of boring, and my heart rate doesn't get up much past 100. So yesterday we stopped at benches that are situated around the lake and did some intervals by stepping up onto them. I would do a minute on each leg, per bench. Nice!

I am pretty determined to keep exercising during chemo. Its one of those "things" that I'm focusing on to help get me through this. I've read that the effects are cumulative. For those who have gone before me in this...is that your experience? I know during week 2, my white blood cell counts will dip and I will have to be careful about exposure to germs and stuff. I'm wondering if that means no gym? Maybe I'll have to start to browse the Exercise TV listings to see if there are programs I can do at home. I wish I could use handweights. That will be one of the questions for the physical therapist next week. I'm doing the Making Strides Against Breast Cancer 5k on October 17th. That will be right before round #3. Of course, I know there is always walking. I live in a pretty hilly area and could probably get a good burn on with a power walk. I don't usually do those since the trails are unpaved and I usually have to push Jean-Marc in the stroller. Although by the end of this, there will probably be some days that walking down the street to the mailbox will be a triumph.

All of these ramblings aside, I know it will work out. (No pun intended!) I just have time to think right now and try to strategize my approach. Maybe I have too much time on my hands!

My prayer requests today:

• That any floating cancer cells in my body are responsive to chemotherapy. This isn't a given. One advantage of doing chemo before surgery (which I opted not to do), would have been to know that the cancer was or wasn't responsive to chemo. Now I'm in the dark and have to just trust that it will work. I started thinking about this over the past couple of days.
• That my body continue to heal from surgery.
• That the sunburn pain feeling goes away. I'm pretty sure that I'm off the hydrocodone for good. I've only taken Advil over the past 3 days, and I'm not always on that.
• That I sleep tonight. The last 2 nights, I've not been able to get back to sleep after waking up in the night. I guess that is the downside of not being on a narcotic!
• That I accept my changing hairstyle(s). And lack of hair. I really don't like my hair right now anyway. But the thought of being bald is on my mind still.

Post Op with Dr. K

The drains came out today!

As I suspected, two of them were definitely ready to come out. But the third was borderline. It was putting out about 50 cc's of fluid each day. At first, Dr. K wanted to leave it in. But since we live in North County, it would be more difficult for us to get back down in a few days to have the last one removed. She gave me the option and I chose to have her take the third out.

The drains basically help my body remove fluid buildup around the wounds on the inside as they heal. There is a give and take with having one or more in longer. The longer they are in, the more the risk of infection. Frankly, it is gross to have a tube coming out of your body. But if my body isn't ready to have them out, fluid may build up internally. The remedy is to have it drained with a large needle. Gulp. That sounds gross too, doesn't it? Dr. K said they would numb the area before inserting the big needle. Then I thought back to the biopsy. That needle prick wasn't too bad. And it isn't a given that the fluid will build up. Each day that goes by, the chances decrease. Dr. K advised me to put the immediate post-surgical camisole back on and put it on tight to compress the chest to help any fluid disperse. If it did build up, she said it would be very obvious--like a breast growing. So we'll keep an eye on that for the next few days.

As far as having the drains taken out, it was not a big deal. I took 2 pain pills before we went down. My usual is just 1, except at bedtime. So I was a bit lightheaded. She had me lay down and I said a little prayer. She snipped around the sutures and it was out before I knew it. I didn't feel a thing. Then she told Eric that the tubes had been at least 6 inches inside of my body. Yikes! I'm glad I didn't know that before.

She said the scars on my chest were healing quite nicely too. My next appointment with Dr. K is in 6 months, unless something goes wrong. I'll miss her. She was a great surgeon. Anyone in San Diego with Kaiser insurance that needs surgery should request her. (Contact me and I'll give you her full name!)

She is basically handing my case off to Dr. P, the oncologist. I got a copy of my pathology report on the way out. I was trying to decipher it when I got home and comparing it to some books I have on cancer. Although Dr. K (on the fly) said it was a stage 2b, I think it is actually a stage 3a. I'm not positive, and frankly, it doesn't make a big difference what the label is.

The juicy parts of the final pathologic diagnosis:

On the left: Invasive ductal carcinoma. Histologic grade: 3 of 3 (tubules 3, mitoses 3, nuclei 2)

Invasive tumor size: 3.5 cm.

Ductal carcinoma in situ: Present

Type and pattern: Cribriform and solid with necrosis

Grade: Intermediate

Lobular carcinoma in situ: Not identified

Lymphatic vascular invasion: Present

Nipple involved: No

Multiple simultaneous invasive carcinomas: No

Associated findings: Metastatic carcinoma present in five of fifteen left axillary lymph nodes (Largest lymph node metastasis 2.5 cm; carcinoma outside of confines of node capsule focally)

TNM: T2N2a

It's the T2N2a that makes me think it is grade 3 and not 2. The T2 refers to the tumor size (between 2-5 cm), and the N2 refers to the lymph node involvement (N2 means involved nodes are fixed to one another).

We'll find out for sure about staging next week from Dr. P. But again, it doesn't really matter that much. It is what it is. God is in control regardless of the stage. He'll see me through.

My prayer requests:

• That fluid does not build up in my body now that the drains are out.
• That I'm able to get a physical therapy appointment before August 17th. Dr. K referred me to PT to learn how to avoid a swelling of the arm (lymphedema). The soonest appointment they have right now is the 17th of August.
• That I continue to heal and be able to start some exercise to get into condition for chemotherapy.
• An ongoing request is for my family. It is hard on them to have me out of commission. Pray that they be strengthened and given extra doses of grace and mercy towards one another.

Bless you all!