5079 Photos!

Wednesday, July 27, 2016

I forget where I got this: "If the Islamists laid down their arms, there would be peace in the Middle East. If Israel laid down its arms, soon there would be no Jews, Christians, or any other 'infidels' left alive in the world."

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Daughter stopped by for the report.  She took some photos.  Here they are.

The red line high up on the breast is my reaction to the tape.  I always turn red along the edges of that thin transparent tape they use.
The blue spot is from where they injected the dye into the tumor to track the location of the "first-in-line" (sentinel) lymph nodes.  That spot isn't supposed to be there.  It surprised the surgeon.  It won't wash off.  It may end up as a permanent tattoo.  
The yellow is bruising.  The bruising above my hand looks worse in this photo than in real life.
Some of the fullness is swelling, but actually, not much.

A better view of the incision.  See how well the little old lady heals?  This is one week after surgery.




Sigh.  Can you see why I want a major reduction?  Nobody needs to carry that around.  By the way, I'm not lifting them here - that's their normal droop.


I rather like the way my hair looks.
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5078 Hands are not visible if they're black?

Wednesday, July 27, 2016

Ain't no fun when the rabbit got the gun.

--I can find many uses of this, but I can't find the original source. Of course, no contemporary usage credits it, like it's supposed to be original to them? Nah. The earlier usage seems to apply simply to tables turning, to the oppressed rising up, like in country songs about battered wives. But my research also took me to some of the dark scary parts of the internet. The past few years it seems to be used most by people talking about an armed revolt against the government.

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By the way, I strongly suspect that the reason the surgeon didn't want to do the mastectomy was that she had no faith in my ability to heal well from such drastic assault.  I think I proved her wrong.  Piss me off!

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Police shootings in the news.  This is one that happened some time ago, but hasn't been in the news much, but I think it's one of the most egregious, most appalling.

Take a look at this photo:

The man lying on the ground is a health care worker.  The guy sitting is his charge, a kid or young man (age not given, but often described as a boy) with severe autism.  They are near a health facility.  The kid is holding a toy truck.  Someone called the police and said the kid was waving a gun.  The police arrived and got all excited. The caregiver lay down with his arms in the air as the photo shows and attempted to explain to the police that the kid did not have a gun, it was a toy truck.  He tried over and over.  The kid of course ignored all instructions to throw away the "gun".  So a police "sharpshooter" (quotes because he was incompetent) fired three shots, hitting the caregiver in the leg with one shot.

The police then handcuffed the caregiver's arms behind his back, and let him lay there for something like 20 minutes.

Now, here's where it gets even weirder.  The caregiver was lying down with his hands in the air the whole time.  I guess when the cops realized they'd screwed up royally, they claimed that they were shooting at the kid, who had ignored their orders and therefore deserved shooting (he's autistic, remember? and the caregiver had told them that)  and completely missed the (white) kid and "accidentally" hit the (black) caregiver.  Yeah, uh huh, so, um, why the handcuffs?  When you found out the kid had, in fact, a truck, why leave the handcuffs on and why no medical assistance for the caregiver?

As was pointed out in the Trevor Noah video, what is a black man supposed to do to avoid getting shot?  He can't walk toward the police.  Hands up or not.  He can't walk away from the police.  He can't stand still.  He can't lie down with his hands in the air.  He can't lie on his stomach, because then his hands aren't "visible".  What can a black man do to avoid getting shot?  Apparently, nothing.

As you know, I dated a black man for a long time.  He was respectable, intelligent, well spoken, law-biding, strong, and protective. But I'd seen him on a few occasions very nervous around police.  He knew there was no valid reason for them to target him, but he also knew that he had no power to stop very bad things from happening if we'd come up against the wrong ones.


Skip ahead to about 1:22 in the video:

 Here's the story from Snopes: 
http://www.snopes.com/2016/07/22/north-miami-police-shooting/

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5077 Lab report

Wednesday, July 27, 2016

"Education is what survives when what has been learned has been forgotten."

-- B. F. Skinner --

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Saw the surgeon today.  Got the bandages off.  Got the lab report.  

I am healing beautifully.  Well, not beautifully, it's pretty ugly, but you know what I mean.  I can now wear a regular bra and do whatever I want.

The lab says the edges of the excised lump are perfectly clear, not only clear around what she removed (and she did go wide, as I had requested) but clear right up to (and including!) the centimeter around the tumor itself.  Two of the closest lymph nodes (what they call the "sentinel node" and one past that one) were removed and examined, and they are also perfectly clear.  Even though the earlier core biopsy said it was dividing rapidly, the size of the tumor was about the same as determined by the MRI of a few weeks ago.  

That was my biggest worry, and one of the factors in my decision to go ahead with the lumpectomy rather than searching for a surgeon who would agree to a mastectomy - I felt pressured by time.  My #1 priority was to get the tumor out of there before it decided to expand territory, travel, and set up shop elsewhere, and given the difficulty finding another surgeon who would accept my rotten insurance, I didn't feel I had the luxury of time.  Now I do.   We can clean this up later at our leisure.

So, altogether a very good report. 

Next I see an oncologist, and find out what the recommendations are for follow-on treatment.  I'm hoping that radiation will not be required (it probably will be recommended, but I can hope not), and hormone treatment rather than chemo (that's a probability).

Note.  This is important to know!  When there are multiple treatment possibilities, like mastectomy versus lumpectomy with radiation, you, the patient, have every right to choose which to have, which to reject.  No one can force you to accept any particular treatment, even if one is more highly recommended than another, as long as either is medically approved.  As long as the risks and benefits of one over the other are explained to you, you have every right to accept or reject those risks.  It's your body, and you can determine the course of treatment.  Your doctors also have the right to refuse to do one or the other if in their opinion it is not the best treatment for you.  In my case, my surgeon refused to do a mastectomy, but I also had the right to reject lumpectomy/radiation.  All I had to do was find a surgeon willing to do what I wanted (which, with my insurance would have cost time).  In fact, even with this surgeon, if I had flatly refused to even consider radiation, she would have done the mastectomy.  She did tell me that.

So, why didn't I just flatly refuse radiation in order to force her to do what I wanted?  Because I learned a long time ago that you don't piss off your waitress until after your food has arrived.
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5076 Moving along

Sunday, July 24, 2016

"Writing gives you the illusion of control, and then you realize

it's just an illusion, that people are going to bring their own stuff into it."

-- David Sedaris --

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The last three weeks have been very busy.  There was a lot of testing, of course, that kept me moving.  When this all first came up, I started out so very positive, and then things got more and more frustrating, and I got more and more angry.   I believe that one's attitude has a lot to do with medical outcomes, so being put under unnecessary stress made me even angrier, like a snowball effect.  

One thing is my insurance.  They've tried to be very helpful, but ... it turns out nobody much accepts this insurance.  When I called around to schedule the chest xray, for example, I discovered that my local hospital doesn't take my insurance!  Same when I was trying to find a surgeon for a second opinion.  My PCP recommends that as soon as possible, I should dump these guys and go back to just plain Medicare.  Medicare works everywhere.

Another frustration was that no one seems willing to accept that I want both breasts removed, and I DO NOT want reconstruction!  I get looks of disbelief, like an incredulous "You know that means you'll be just flat?"  Uh, yeah.  That's what I want.  The surgeon said she would not do a mastectomy, just a lumpectomy, and her reason was that because I have a long history as a smoker, there's an increased chance that "the flap" would not have enough blood supply, and the flap skin would die, so she doesn't want to make a flap.

Well, I did the research.  First off, the incidence of flap necrosis is in fact doubled for smokers, but as is often the case, a very small incidence doubled is STILL a very small incidence! People tend to forget that.  Secondly, the research indicates that the difficulty with the flap occurs ONLY when the skin is draped over a filler/mold/expander used when reconstruction is planned, because the flap is thin injured skin draped over non-living non-organic material, so the skin must be able to support itself throughout healing.  If you are not planning reconstruction, the skin is laid nice and flat over living tissue, into which it happily grows and shares blood with.  None of the research indicates a common flap problem when no reconstruction is planned.  But, this is the reason she gives for insisting on lumpectomy.

Why do they refuse to believe I want NO RECONSTRUCTION!  Are my breasts so magnificent they can't imagine my ditching them?

(You know, I'm almost believing that, because almost everyone was amenable to complete removal until they saw them in all their glory.  Then suddenly they were against anything more than lumpectomy.)

So, I had the lumpectomy last Wednesday, July 20.  Daughter took me in early morning (arrived at 7:40).  Things did not happen quickly after that.  There was a lot of waiting, with, of course, no food or water since midnight.  I finally got into the OR at 2 pm-ish.  That was kind of funny.  They had taken my glasses, so I couldn't see anything, but there were 10 or 12 people in the OR, mostly women, and it sounded like a party going on.   They have tumor conferences on Thursday, the interesting case of the week, and it turned that the prior Thursday was me.  Every doctor and technician I had seen since then knew all about me.  It felt weird.

We finally got out of there around 5 pm, I think.

I'm all bandaged and taped up, and probably swollen, so I have no idea what it looks like.  The right one is definitely smaller now than the healthy left, but not by as much as I had hoped.  Imagine a volcano shape.  Now blow off the top of the volcano, leaving the base intact.  That's what I seem to have.

They gave me a prescription for Percocet, which I haven't filled.  They chewed up my upper lip and the right side of my jaw inside, so I briefly needed pain killers for that.  But not for the breast.  No pain whatsoever from the breast or from the two lymph nodes removed high on the side of the breast.  Nothing but itching.

The surgery was Wednesday.  Wednesday evening blood showed in the gauze through the transparent bandages.  Thursday morning the red was replaced by pale yellow.  By Thursday evening there was nothing there.  The gauze actually looks almost clean, which is weird.  Thursday morning the itching started.  That's supposed to be good.  There's some slight tenderness off to the side, pretty much where the lump was.  And that's it.

The lump and lymph nodes went off to the lab.  I'll find out what the lab says when I see the surgeon in a few days.  According to my research, something like 30% of lumpectomies show "dirty" edges, and you need a second surgery to get to clean edges.  That's a part they never tell you.  I told her if she was going to insist on lumpectomy, she should "go deep, go wide, take a lot more than you think you need, I don't want to see dirty edges, and remember cosmetic result is not a consideration", so we'll see.  I will be absolutely pissed if we have to go back in there.  Um, considering I wanted a mastectomy.  Once and done.

Also in a few days I'll find out what kind of follow-on treatment I need.
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