So, what should I look like?

I've been really anxious about all of the surgery I have in my future. We've gotten comfortable with the decision to do the bilateral mastectomy, rather than just the right breast. I'm only 35 now, and, because of the BRCA2 mutation, my chances of having breast cancer again in my lifetime are very high. Rather than spend the rest of my life in a cycle of worry-mammogram-biopsy-worry, Zack and I decided that it would be better for our quality of life to remove the left breast along with the right. As Dr. S says, "it's just an overgrown sweat gland". (Here's hoping the insurance company agrees with our assessment. All my doctors have offered to write letters and fight for me if it comes to that.)

Yesterday, Zack & I met with a plastic surgeon about the reconstruction options. Dr. L spent over an hour with us - it was really incredible. The biggest decision to make up front is whether to do a primary reconstruction (where the plastic surgeon would begin the reconstruction process during the same operation as the mastectomy), or a delayed reconstruction. Radiation does nasty things to skin, other tissues, and implants. Therefore, the chances of complications go up astronomically if I start reconstruction before the radiation. Bottom line: because I'll need a heavy series of radiation treatments after the mastectomy surgery, there isn't a lot Dr. L would be comfortable doing until that process finishes. Zack and I feel strongly about avoiding complications that would lead to extra surgery, so we've decided not to take the risk.

For me, this means that I'll wake up after the mastectomy with a completely flat chest. In some ways, I welcome this opportunity to see if I mind that body shape before making a decision to change it. (I just had a flashback to being the last girl in my gym class to wear a training bra). Zack, of course, has been absolutely supportive of whatever decision I ultimately make. His only concern has been my emotional well-being: he worries that the dramatic change will be hard for me to assimilate.

Our meeting with Dr. L took a lot of the pressure off, because we don't need to make a decision right away about what sort of reconstruction to do (implant and/or using part of a back muscle). Federal law requires insurers to pay for post-mastectomy reconstruction whenever we decide to do it - even years from now. The reconstruction process takes longer than I thought, though (4-6 months).

Overall, we are happy about our decision to wait because it matches our priorities. Step one: beat cancer. Step two: figure out a cup size.

Over the hill (almost)

I'm officially halfway through what should be the hardest round of chemo. My mom wins huge points for braving Black Friday. Yesterday, I felt well and was able to accomplish lots of things (adhering to the 20:40 rule). Today, though, I feel like I am back at square one. Did I overdo? Did I eat something out of bounds? Is it the luck of the draw? Here I thought I had chemo figured out and all of a sudden I get a nausea curveball.

Anyway, it is back to the couch with a book for me. Keep your collective fingers crossed that it is only a one day thing.

The 20:40 ratio

So, after a month of chemo, I've decided that a positive experience revolves around respect for the 20:40 ratio (20 minutes of activity to 40 minutes of rest). If I follow this ratio, I have a good day. If I ignore it, I get overtired (with all of its miserable sequelae: weepiness, soreness, overwhelm,...) or bored (followed by feeling worthless, restless, career panic,...)

It is also clear that there is a night and day difference between week one and week two of the chemo cycle (reference my rather whiny post of a few days ago). Last week I thought I just couldn't do 5 more cycles of this. This week, I am (pretty) sure I can. There is just something indescribably awful about the combination of exhaustion, nausea, and fluttering attention that comes in the first week of chemo. And the sneakiest, hardest part is that there is a tiny possibility that the sick phase won't end until the chemo does in November. That the first cycles were the flukes and that 'now, THIS is what chemo will REALLY be like'. Even a bad flu ends in a week or two. And a rough pregnancy ends with a baby.

Here I am, though, back in a good week. (Praise the merciful stars.) Although my energy is still low, the 20:40 ratio feels like a challenge rather than a limit. ('How much can I get accomplished in 20 minutes?') And I am beginning to think of all the things I've ever wished for long swathes of time to do, or to learn. I am, of course, limited by the 20:40 rule. But, for instance, I could practice sewing pants and jackets in 20 minute bursts. I was thinking that I could check out a combination of fashion magazines and K/atherine H/epburn movies for ideas. (KH movies being great for the :40 side of the ratio).

Still, even with this insight about good weeks, questions remain:

But how to do the 20:40 ratio on the bad weeks? If reading a novel or watching a movie is a 20: side activity, what could possibly be on the :40 side?

I still wake up in a panic about schoolwork most nights. How to write a dissertation following a 20:40 rule? 20:40 does apply to thinking work, too. It feels like being a smart person only 1/3 of the time. (yes, all you people who rely on your smarts, it is absolutely, gut-wrenchingly, abjectly terrifying)

How to make sure, 100% of the time, that Zack knows I'm crazy about him, even though - especially in the :40 parts of bad weeks - he does all the work?