“When a forest burns down it can come back greener.” I believe in this now more than ever before.
I was a healthy, happy 46 year old with a wonderful marriage, two awesome teenage sons, two dogs, a successful business and was deeply involved in the community. I never would have thought I would be “that” person to be struck with this disease. But, why not? Breast cancer knows no boundaries. After five surgeries, seven weeks of daily radiation, 16 months of emotional and physical ups and downs and a Google map of scars, that person is healthy, happy 47 year old me. I've never posted my story publicly, but we all should. By putting it out there, you are helping those women who may someday face this journey. They need to know what you’ve been through and that you’ve come back stronger. I think they call it inspiration.
My husband had lost his only brother in February last year at 45. Our family was reeling from this loss; it was really dreadful. Then in April it was my routine annual mammogram, which I have thankfully been getting since I was 35. I was in there a long time, longer than usual. They had found a suspicious cluster of microcalcifications; some can be normal residual from milk, but some indicate the presence of ductal carcinoma in situ, or DCIS. After a very unpleasant "stereotactic" biopsy, my diagnosis was the latter.
Lumpectomy #1. I had a wonderful surgeon, Babak Rashidi, who assured us this was early stage, non-aggressive, and restricted to my ducts—meaning it had not spread into my breast tissue itself. This is how they handle this type of breast cancer: they remove the area of concern without radical surgery. When the margin came back positive for DCIS, he needed to go back in and get a little more, so that he knew he had a clean, non-cancerous margin.
Lumpectomy #2. 10 days later the nursing staff asked me why I was back so soon. One more minor surgery and I'd be finished. Rashidi called with the good news: the margin on the second was clean and I was now free to go meet with an oncologist to plan the next steps.
Radiation. It's often protocol post-lumpectomy to insure that any remnants of DCIS are killed off. We met with Farley Yang at Virginia Piper Cancer Center and scheduled 37 sessions of radiation to the left breast every morning at 8:30. What a way to start off your day. No pain, not even any discomfort. It was just scary and sad because all these people who went there every day like me were really sick. I never thought of myself as sick during this whole process because I hadn't been through anything compared to them. The last day in July was session 37. I thought I would feel relief and closure, but in a way I was cast out on my own. I was going to miss these great people who I had seen every morning all summer. It was much more emotional than I had ever anticipated.
Tamoxifen. Another piece of protocol, and one more piece of insurance. This breast cancer drug was prescribed for me and I began taking it right after radiation was over. Side effects are generally negligible, but I am a statistics buster, so if there were side effects to be had, I probably would experience them. I hate taking drugs for this very reason. By September, menstruation had come to a screeching halt. Some might think this is a welcome change, but it came with brutal soaking night sweats and all the other garbage that comes with menopause. Tamoxifen is an estrogen blocker, given to breast cancer patients to minimize the hormonal feeding frenzy by potential breast cancer cells. Oh well, I was going to hit menopause anyway, just not so intensely.
Now, I really was done. At our annual Gala at my son's high school, Notre Dame Prep, I was on top of the world. I had dodged a major bullet and chaired this awesome event that had gone off without a hitch. The fall was great, with holiday parties and Christmas celebrations. At the end of December, I decided to get my follow up mammogram instead of waiting until January (so I could avoid an entirely new insurance deductible). Andy and I went to SMIL on New Year's Eve day.
I sat in the hall, waiting, even longer than before. 2 1/2 hours of films, ultrasounds and asking my mom for help. I had lost her in 1996 to a brain tumor, and she went through so much. I needed her more now more than ever. Poor Andy was beside himself waiting for me. Finally, they told me he could come back to the darkroom with me so we could talk to the radiologist. After nearly five months and all the radiation, they saw four areas—this time on the right AND left—that they wanted to biopsy. They were the size of sea salt crystals. How could something so small create such a mess?
My oncologist called within an hour after I got home. I was told consult with my surgeon again. This may require a different plan. We visited Rashidi and got the straight scoop. There were no more lumpectomies to be had. We could biopsy the right breast, but then what was the likelihood of this coming back positive again and again? This early stage cancer could potentially turn into something much more serious. This was no time to be vain or silly. In my mind the decision was already made. The longest day of my life was waiting for the results of the CT/PET full body scan—which is mandatory prior to surgery. They had to make sure there was no invasion of the cancer to any other tissue in my body. When I got the call, I was beside myself. No lymph node invasion. I really had caught this in time.
Bilateral Mastectomy. Wow. God bless my husband, my family, my friends. I couldn't have gone through this without their constant concern, love and support. The next thing I had to decide was whether or not I was going to get reconstructed. There was no hesitation. Insurance would pay for as many surgeries as necessary, and frankly, I couldn't imagine just ribs, skin and scars for the rest of my life.
I have many friends who have had augmentations. I always said that plastic surgery was never in the cards for me. Yet, there I was, meeting this incredibly poised and lovely doctor who put me at ease from the start. Dr. Trojanowski. I knew I didn't want a celebrity boob doctor, and I needed someone whose specialty was “making a silk purse out of a sow's ear,” as my mother used to say. She told me reconstruction would be difficult on the radiated breast, due to the high levels of damaged tissue, muscle and skin. The process would be long and arduous, not to mention uncomfortable. After that meeting, we scheduled the surgery for January 26th. She and Rashidi would work side by side, him removing my breasts and her installing the tissue expanders and closing me up.
I cannot lie. The pain from this surgery was intense. When they put in the tissue expanders during the same surgery, the pectoral muscles are completely cut away and these uncomfortable Tupperware lids are put in empty. They sent me home with a lot of drugs and drains coming out of my breasts, which needed to be emptied of post surgical fluid every few hours. My sister Ann and my husband Andy were my saviours. My house looked like a florist shop. My friends came from school and from the neighborhood for days upon days with meals and flowers and nothing but love. What a gift.
Over the subsequent three months, Dr. Trojanowski would see me weekly to slowly begin the expansion process by injecting saline into the ports. Over time my tissue would stretch to allow the placement of permanent implants. The ultimate boob job! So we s-t-r-e-t-c-h-e-d as much as we could. My initial mastectomy scars were looking pretty good, but my left breast was not taking the fills very well and was looking tight, shiny and red. I was in some very significant pain all of a sudden due to radiation. She told me the only way we would be able to get any kind of quality results would be through another surgery that migrates a section of my back tissue, skin, and latissimus dorsi muscle, moving all of it to my breast without ever removing it from my body. That was the craziest thing I would ever hear.
Latissimus Dorsi Flap Surgery #4. In April, Trojanowski worked her magic. I went into surgery not knowing if she would even be able to perform this "flap" because the condition of my breast was so bad and frankly, until she got in there she wouldn't be able to tell. The process is incredible. It's like the virtual cut and paste: the concept of healthy tissue from another part of your body helping to build a breast and hopefully making the surrounding radiated tissue get better. Wow. During this same surgery she was able to switch out the expander in the right breast with a permanent implant. One-stop shopping!
This is where my Google Maps come in. My right breast had a straight mastectomy scar. My left breast had a very interesting elliptical scar, which is actually my back tissue. I had a 7 to 8 inch boomerang scar on my back. But the surgery was successful. The lat flap took beautifully and gave me instant relief from the painful tightness I had lived with. And my right breast was, well, pretty nice. It's all about progress. I now had another expander in the left. With the lat flap done, Trojanowski would continue to stretch the left to get it caught up with the right. Expanders are definitely not fun, but I was so drastically improved from before this surgery. I didn't even think the post-op recovery was that bad. I was healing on both sides of my body.
Almost done. July 1, just last month, Trojanowski finally replaced my left expander with a permanent implant. Surgery #5. I have two breasts again. No nipples, but maybe I'll get those for Christmas. That is an entirely separate topic for another submission, and it involves minor surgery and tattoos. So I'll have fake breasts and tattoos—the envy of many women, right?
Through all of this I was inspired. By people who touched me and people I talked to who had been through this. My doctors were amazing. I have now cancer-free. And now I want to take this experience and give back.
The BAD GIRLS. I have formed a Breast Cancer 3-Day Team called the BAD GIRLS. You guessed it. That refers to my breasts—when I first had my mastectomy, I couldn't look. So I asked Andy to. Well? He said, “Well honey, those BAD GIRLS are gone.” So that was the birth of our team name. I have seven other amazing women, and we have raised nearly $10,000 against our goal of $30,000.
All of this time has empowered me. I dress like I want to. I am not a victim, I am a survivor. I am not afraid to talk about my experience because it is a reality that one in eight of us will face. I don't want these girls to be afraid or to think it's the end. I got through this by maintaining a positive attitude in very dark times, and by making it a goal to keep my life as normal as possible. Now I can take this experience and make it mean something for someone else. I know the ins and outs of what you need, what will help, and what you may deal with both physically and mentally. You need strength and encouragement to get through it. Most importantly, you need to take charge of your health. Be responsible, and don't be in denial. Denial chews up time, and if you have a reason to take action beyond your annual mammograms, don't walk away. Time can be cancer's best friend. We don't want to leave unfinished business, especially when it comes to our breast health.
Fast forward to the greener forest. I am chairing that awesome event again this year, working in the real estate industry and loving it, and feeling stronger and more positive than ever. My oldest graduated from Notre Dame Prep and is headed off to college next week. And my younger one started there as a freshman today. Survival brings you opportunity for reflection and appreciation of what is important. It makes you realize you are lucky to be here, and gives you confidence to close one chapter and open another.
This really felt good. I have never written all of this down, and maybe someone will read it and be inspired. My website, www.sallycashman.com, has a survival story page tab with a link to the 3-Day. You are welcome to pay me a visit, and I would be happy to chat with you if you or someone you know is facing this process. Thanks for the opportunity to share my story. Survival is a beautiful thing.
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