Final reconstruction and hair update

I'm just under two weeks out from my final reconstruction surgery.  I have admittedly been going a bit stir crazy.  The funny thing about this surgery is that I felt pretty good pretty quick, but I know that my body isn't healed and I certainly don't want my impatience to cause a complication or poor cosmetic outcome!  I've been sticking to activities that don't use my arms and don't get my heart rate up.  Thus, my primary exercise has been walking around the neighborhood and riding the recumbent bike at the gym.  Walking is fine, but it has been insanely hot in the valley this week and I can only handle about 45 minutes on the recumbent bike before I'm bored.  I have certainly been short on my daily quota of exercise to keep me smiling.

Yesterday, I visited my plastic surgeon for my first follow-up appointment.  Everything is healing really well, but yes, I still need to wear the bra-thing for another week!  Fortunately (one of my co-workers) suggested that I wear a tank top under the bra-thing and while it is still annoying, it is way more tolerable.  I have also purchased a high impact sports bra to wear when exercising.  My plastic surgeon (kind of) says it is okay to wear.   My PS also (kind of) told me I could do activities as tolerated. Actually, I think he said don't do anything that hurts, and I interpreted it as do anything that doesn't hurt.

So, today I finally got some nice, cool mountain therapy.   Dizzy joined in on the fun.  Notice the smile on both of our faces.

Despite the big smile, I am truly disappointed by how little hair it looks like I have in this photo.  When I look in the mirror, I see a head full of hair and I do not think I am delusional.  I think the sun was hitting my head just right.......Anyhow, I'm really digging the buzz cut look.  Perhaps it is because I haven't had hair for so long or maybe it is because it is incredibly easy or possibly because all of my kids at work say "Cool hair cut"!

While hiking, we witnessed a pretty large rock slide on an adjacent peak.  It was so loud that it sounded like it was on top of us, but fortunately we were safe.  At first I thought it was a tree falling over, but then we saw the rocks moving and smoke in the air.

My tentative plan, because I always need a plan, is to get on the road bike Monday and then the mountain bike a little over a week from then.  I think I will bring out the full-suspension...............

Tips for staying fit and healthy while undergoing chemotherapy

Chemotherapy was not easy.  In full disclosure, I had some really bad days.  I still do.  But I had many more good days.  My primary goal while undergoing chemo was to live life to its fullest.  My goal as a competitive athlete (who hopes to compete again),  was to maintain fitness and to stay healthy.  For me, the two goals were completely intertwined.  Now that I am over two months out from my final infusion, I can say with some certainty.....GOAL(s) MET!

Although I am certainly not an expert, and realize all women experience chemotherapy differently, I feel like I now have enough perspective on my experience to share my personal strategies for meeting my goal of staying fit and healthy while undergoing chemotherapy.

1.  Keep moving.  There is quite a bit of research that supports the importance of exercise during chemotherapy, however I don't think it is emphasized enough.  In my experience, exercise is the single most important way to feel better during chemotherapy.  Somedays it may be a short walk and/or stretching.  Others it may be a 2-hour mountain bike ride.  Doing something always felt better than doing nothing.

2.  Keep a log of how you feel each day over your first infusion cycle.  For example, Day 1 post infusion I had minimal fatigue.  This was a good day to take advantage of a nice mountain bike ride.  Days 2 & 3, I felt like dirt.  I would plan to take the dog for a walk to get outside and then stretch. That's it.  Day 4 through Day 7, I started to feel better physically each day, however I still only tolerated bland food.   Each proceeding day I would feel a bit better until my next infusion.  I would plan exercise and meals accordingly.

3.  Have simple goals and try not to compare yourself to pre-chemo performance.  I put away my heart rate monitor and bike computer.  My exercise goals became very simple.  To maintain conversation pace and to keep my rides under 2 hours.  In my opinion, a heart rate monitor is useless for monitoring zones during chemotherapy anyhow.  My zones most likely changed daily.  As for keeping my rides under two hours, I noticed that if I rode for more than two hours, I would feel fatigued instead of invigorated.

4.  Try not to set yourself up to feel bad about yourself.  No matter how much fitness you are able to maintain during chemotherapy, you simply are not going to feel as strong as you did before.  I tried to ride with people who were not out to do hard training rides, but content riding at conversation pace.  Pushing myself hard to keep up was not a goal of mine during this time, while being dropped hard was bad for my fragile self-esteem.  My husband was especially generous in that he would always let me stay a wheel length ahead.  No matter how slow I was going, this little trick helped me think I was strong.

5.  Eat healthy.  During chemotherapy I started experimenting with a mostly vegan diet.  A vegan diet is not for everyone, but eating healthy meals really does help improve energy and you need energy to exercise.  Eating healthy also helps prevent weight gain.  It is well documented that most women gain weight while undergoing treatment for breast cancer.  Through exercise and a healthy diet, I was able to maintain my weight throughout chemotherapy.

6.  Eat something.  I found that the first week post-infusion I only tolerated bland food such as toast or pasta marinara.  My options were to eat a less 'healthy' bland diet this week or not eat.  For me, eating was always better.

7.  Do what you love.  Obviously I love riding my bike, but I feel most alive and free when riding awesome singletrack.  Anticipating a fun ride made it really easy for me to get out and exercise even on bad days.  In fact, riding singletrack provides such an endorphin rush to me, that I would often forget, for just a moment, that I was undergoing chemotherapy.

8.  Take care of your body.  I did acupuncture throughout treatment and had some incredible cranio-sacral sessions at the Cancer Wellness House.   I really think these sessions helped me stay strong and healthy allowing me to exercise and maintain fitness.

Well....that's it.  Those are my main tips for staying fit, healthy, and for me, happy, while undergoing chemo.

Now, if I could only figure out how to stay happy (and not cranky) while following post-surgical precautions........

Post-Final Reconstruction surgery

Last Monday I went under the knife for what will hopefully be my final surgery related to breast cancer.  The lead-up to surgery wasn't exactly full of epic last rides; other more important, and not exactly happy things came up.  That said, I did have the opportunity to test my fitness prior to surgery.  I jumped into a few Tuesday night races and I'm happy to report that I can still keep up with the fast girls! (at least for short distances)

As for recovery from surgery, so far, it seems to be going well.  My favorite anesthesiologist gave me what she calls the cadillac treatment and as usual I woke up quickly and was ready to get home.  The total procedure only took about 2 hours, but of course, with surgical delays we were at the hospital eight hours.  Once home, I was recovered enough to have a full dinner.

The worst part about the surgery (so far) is that I woke up in this compression bra:

Besides being ugly, it is horribly uncomfortable.  I am supposed to wear it 24 hours a day, for 3 weeks, except when showering.  I've been taking very long showers.........This is the most miserable $90 bra I have ever had, and now I have two!

Pain has been quite manageable.  I took Lortab day 1, Tylenol day 2, and nothing today.  So far, the incisions look good, but I have strict precautions for at least two weeks.  Basically, I am not supposed to do anything that stretches or puts tension on the incisions.

My hopes are to get on the trainer at one week post-op, road bike at two weeks, and mountain bike at three weeks.......It's going to be a long few weeks, but then again I have already managed to somehow keep my sanity with eight months of treatment....

Once I am completely healed and back to normal activities I will be able to officially celebrate being done.

Reconstruction

Talking about your breasts is a pretty personal thing, talking about reconstructing your breast after a mastectomy is even more personal.  Not something I would ordinarily talk so openly about, but it has really helped me to approach this experience very methodically and openly.  I warn you in advance that this post is blunt and to the point.

The time has come for me to have my final reconstruction.  My entire life, I have never once considered having plastic surgery, especially breast augmentation, however when given the choice between plastic surgery or no breast....I choose plastic surgery.  Perhaps I am more vain than I thought I was.  Really I think I just want to be able to wear the clothes I like, look good, and not worry about symmetry.

One of the hardest decisions of my life was back in March when I chose to have a mastectomy.  Since then, I have spent a tremendous amount of time learning about reconstruction methods.

The easiest method of reconstruction is to use an implant.  This surgery is relatively quick and usually results in a nice perky breast.  The problem is, real breasts aren't as perky as round implants.  So then the decision needs to be made if you want to have an implant placed in your other breast to help with symmetry.  This adds another surgical site, and since you are adding an implant makes your breasts larger than they originally were (although you can choose how much larger).  The end result is two perky breasts that hopefully have good symmetry.  Although this is the simplest reconstruction method, there are some downsides.  Implants don't last forever, even in straight forward augmentation (boob jobs).  Additionally, reconstruction with implants often is not successful for women who undergo radiation.

Another method of reconstruction is a flap procedure.  Surgeons take fat, muscle, and a blood supply, usually from your abdomen or trapezius, and somehow reposition it to your breast.  Obviously this is a lot more invasive than implants.   Not only is recovery time longer, but since muscle is sacrificed there is a good possibility of reduced strength or muscle imbalances.  Surgeons, however, seem to like this technique  because the blood vessel is pulled from the original location to the breast and no reattachment is necessary.  For me, this was never an option.  I'm simply not willing to sacrifice muscle for reconstruction.

The final method involves fat, skin, and associated blood vessels being taken from the abdomen, butt, or inner thigh and transplanted (actually removed and then reattached) to the chest wall.  The surgeries are called DIEP, S-GAP, or TUG depending on where the tissue comes from.  No muscle or motor nerves are sacrificed with this procedure and a gifted microsurgeon can produce amazing results.  I've heard some women say that their new breast perfectly matches the other side.  The downside of this surgery is that it is an incredibly tedious surgery; often patients are under general anesthesia for up to 10 hours, thus increasing the risk of surgical complications.  After surgery, if all goes well, there are strict precautions for up to 6 weeks.  This procedure also requires a sufficient amount of adipose tissue in either the abdomen, butt, or inner thigh so often is not a viable option for extremely thin women.

To help me make my decision, I have met with three different plastic surgeons as well as consulted via telephone with a microsurgical specialist in New Orleans.  Since I had taken flap procedure off the table, I had two options: implants or S-GAP.  I am a perfect candidate for implants because I am young, healthy, and did not get radiation.  I was told that I was also a candidate for a S-GAP.  Apparently I have enough butt fat to build a small breast.

Based on this information, I have decided to have implant based reconstruction.  I chose this procedure because of the reduced surgical and recovery time.  I have also chosen to have my 'other' breast augmented slightly to help with symmetry.  So the end result should be slightly larger and more perky than I was before.  Although I wasn't really looking to increase my breast size, I do want to have good symmetry, and S-GAP aside, this is my best chance for that.  If for some reason this is not successful, I can always pursue the S-GAP in the future and the 'other' implant can be removed.  There are also new reconstructive techniques emerging all of the time.  Maybe, down the road, there will be a procedure that uses your own tissue without the surgical risks and extended recovery time.  In fact, one of the plastic surgeons mentioned one such new technique.

I did not take this decision lightly, in fact, it probably took me a few months to come to a final decision.   Seriously, my plastic surgeon just found out my final decision this week.

I would advise anyone who has to make this decision to meet with multiple plastic surgeons.  I found that different surgeons feel more comfortable with different techniques.  If one surgeon is not trained in a specific technique, he/she may not mention it as an option.

This week when I met with my plastic surgeon I told him my final wishes.  I said words that I never thought would come out of my mouth such as 'I don't want my breasts all jacked up, try to make them droop more like natural breasts'.  Apparently this is possible.  and 'I want the very smallest implant possible'.  Throughout this process he has been very respectful of my desires and I feel that he truly understands my wishes.  We'll see.......Surgery is August 15th.

6-week anniversary

To celebrate my 6-week anniversary since my last chemotherapy infusion, I got to visit my oncologist today.  Overall, the appointment was a breeze.  I had blood drawn for labwork, a physical exam, and I got to ask my rather short, but always interesting, list of questions.

Today's appointment reinforced what I am feeling; that I am doing well.  I am happy to report that my labwork results look really good!  Everything continues to be in the normal range and my red blood cell and hematocrit levels are creeping up closer to my personal baseline in February.  No wonder my energy levels are increasing.  I am not scheduled to see my oncologist again until December!

The past six weeks have gone by pretty quickly.  I have spent the summer nurturing my body and hitting all of my favorite singletrack up in Park City.  It has been nothing less than sweet!  I have also spent a good amount of time watching and supporting at bike races.  I genuinely enjoy doing this and seeing fellow racers, especially women, achieve their personal goals.  That said, I get bummed that I'm missing out on the epicness (is that a word?) of the experience, especially when I see high quality ultra-endurance events.

There were two such events that I got to watch this summer.  The first was the PC-50. This 50-mile race in Park City (part of the Utah State Championship Series) somehow found 50-miles of super-fun singletrack to link Park City Mountain Resort to the Canyons.  I've ridden most everything up in Park City, but this course found some gems that I have never been on.  Since my husband (along with 3 others) promoted this race, I got to see first-hand how tirelessly they worked with the highest priority being to make it an excellent experience for the racers.  Based on the racer vibe at aide station #2, the race was a huge success.  It should also be mentioned that the payout was HUGE and deep.  The fastest male and female went home with close to $1000 each!

Steamboat appears to be mountain living at its best

Another super cool event that Shannon and I traveled to was the Steamboat Stinger. This 50-mile race was also a first year event held in Steamboat Springs, Colorado and was promoted by, you guessed it, Honey Stinger.  The town seemed genuinely excited to host an ultra-endurance mountain bike race, the race promotion was slick, and the course stellar.  I definitely want to return next year!  Even though I didn't get to race this event, I did achieve my goal of completing a 25-mile lap with 4000 feet of climbing....rather easily.  We also had a great time staying with great people and meeting some new friends.

My attention is now turning to my final reconstruction.  Next week, I meet with my plastic surgeon to reveal (and I do mean reveal, as in I have changed my mind quite a few times and he probably has no idea what I'm thinking:) my final reconstruction decision.  Surgery is scheduled for August 15th.

and if you haven't read enough already, here is a link to a blurb that Gene Hamilton with BetterRide (skills training and coaching) posted.  I attended a BetterRide clinic last fall and it completely changed and improved my riding technique.  I continue to do my 'drills' and am hoping to see big payoff when I start racing next year. Gene found out about my diagnosis last week.

(lack of) Hair

I did not lose all of the hair on my head during chemotherapy.  Only about 75%-90% of it:)  The funny thing is that the hair that I did keep kept growing.  It made for an interesting look for a while.  Well, I have finally shaved it (again) in hopes that my hair will grow in more even.  I am starting to see some little hairs burst from the follicles.  Very exciting stuff!

I really do not mind the simplicity of not having hair.  I'm really not a big fan of styling, and now I can seriously take a shower in less than 2 minutes which leaves a lot more time for things like.....blogging.  I even think I look pretty good bald (ok, so I exaggerate); but I definitely look more bad-ass than I've ever looked before.

Honestly, though, I am very self-conscious about not having hair.  Even though I strut around my house hatless all the time; I have not gone out in public without something on my head.   I think it is because the bald head is like announcing to the world that I have (had) cancer.  I realize the irony that I write a blog about my experience with cancer, yet I don't want to go out in public and be thought of as that poor girl with cancer.  Interestingly, I must be good at not looking like I just finished chemo as not once has a stranger asked me a question about my headwear or treated me like I was sick.  I like that!

So, without further ado, here I am:

I'm trying to look as bad-ass as I can.  Notice the rain drops and cloudy sky.

Profile of my bald head.  Notice the beautiful blue skies.  

This is 15 minutes later; storm passed, sun out, need sunglasses.

I really wanted a more professional bald photo with beautiful scenery in the background, but we haven't really had time for that, and thankfully I'm running out of bald time.  Our deck will do!

Not related to hair, but warranting mentioning, my body seems to have adjusted to the Tamoxifen.  The muscle cramps seem to have gone away.   Yeah!!!!!

I also had an incredible acupuncture appointment yesterday.  Today, I feel like a rock star.

Little White Pill

Monday I started Tamoxifen.  This little white pill will be part of my breakfast for the next five years.  I already have a love/hate relationship with this pill.  On one hand, it is very effective.  Tamoxifen blocks the actions of estrogen, and since my breast cancer is estrogen receptor positive (it requires estrogen to grow), it reduces my chance of distant metastasis, local recurrence, and new breast cancer by about 50%.   On the other hand, it is a medication, and like any medication it has side effects.  I know many women who take tamoxifen with little to no side effects (I'm hoping to fall into this category), but then again I have heard horror stories as well.  I have had significant muscle and joint cramps/aches this week.  I did get out for a nice bike ride yesterday and a good hike today; exercise seems to help.  But not for long.  I'm hoping that as my body acclimates to the new medication, that the annoying discomfort subsides.

Another new consideration is that I need to consciously avoid soy and flax products.  Both soy and flax are very strong phytoestrogens and they may compete with Tamoxifen for estrogen receptors thus reducing effectiveness.  I realize that soy is in just about everything making it next to impossible to completely avoid, but I am going to make an effort to avoid foods with soy listed on the ingredient label.  I certainly don't want to be taking this medication only to reduce its effectiveness by eating the wrong food.  This may not sound like too big of a deal, but do you know how hard it is to find an energy bar that does not have soy OR flax?  I have been scouring labels, to no avail, please let me know if you have any suggestions.

***Blog Amendment: After consulting with the nutritionist at Huntsman, it appears as though flax is potentially okay to have in my diet even though it is a very strong phytoestrogen. Although there is no current research on humans, according to an article from the American Institute for Cancer Research, flax had an enhancing effect for Tamoxifen when tested on mice***

Besides this, I have been keeping myself surprisingly busy for being off work.  or maybe I'm just good at wasting time?  I have been exercising (almost) every day and worked my way up to a nice, easy 3-hour bike ride on part of the PC-50 course last week.  My current motto for exercising is to keep the efforts at conversational pace.  This is allowing me to maintain some fitness, reap the therapeutic benefits of being on my bike, and not overtax my body as it recovers from chemo.

One of the bigger creek crossings in the PC-50

I have also continued with my plant-based diet.  Last week's theme was cauliflower and quinoa.  I now have 3 really good recipes with cauliflower, one that includes salmon (ok, so not completely vegan, but pretty close).  As for the quinoa, I did not have as much success.  One of my recipes wasn't clear on how to prepare it and it ended up being undercooked.  The other, quinoa and veggie stuffed bell peppers, was pretty good....not great.  To top it off, I finally bit the bullet and purchased a Vitamix blender today.  One of my co-workers has generously 'loaned' me hers since February.  She called me today to say that she saw them at Costco for $100 off (hint, hint).  The sale is for 3 more days, so if you're thinking about getting a Vitamix..........

This really is a green smoothie.  It has loads of Kale and red cabbage.  It also has protein powder, MILA, banana, strawberries, blueberries, and blackberries.  

Next week it is off to Steamboat I go.  I can't wait to explore some new trails.

Dizzy loves to hike.  He doesn't love to come....