Tuesday, August 01, 2006

What next?

The past month or so I've been struggling with a major decision. Much like when I was 18 and I couldn't decide between two colleges, I went back and forth. Northwestern on Tuesday, NYU on Wednesday. Mom asking what I was going to do on Friday. Still not sure. Finally, on the last day before I had the mail in a decision, I yelled, "Fuck it, I'll go to Northwestern. Mail that one in, Mom." as I walked out the door.

So has been the decision on what treatment to do now that chemo is over. What? You say...More treatment? Yep, more treatment. See in breast cancer, there is local treatment and systemic treatment. Local treatment is to the breast itself and either means lumpectomy and radiation or a mastectomy. Systemic treatment is chemo. I won't even go into hormonal treatment.

Part of my local treatment is already taken care of. I had a lumpectomy. So the standard of care would be to go in and have radiation. However, I've been debating going back in for surgery and having a mastectomy. Actually, I've been thinking of having a double (bilateral for those in the know) mastectomy. Figured if I'm going to cut one off, I might as well have a matched set. And I've been going back and forth. One day, I'm like, "screw it, cut 'em off". The next day, "Damn, I just want to be done."

All of my doctors tell me they are comfortable with me getting radiation. Good, I'm so glad they are comfortable. Let me know when they have cancer. I am told the survival rates are the same for lumpectomy/radiation and a mastectomy. They ask me why I'd want to go back in and cut them off. See, I don't give a shit about survival rates. I'm not worried about dying. At least not today. I'm worried about this bitch coming back, only next time I'll have 3 kids under 10, and I'll have to explain to them why Mommy is sick. Man, it was hard enough this time around. No one seems to give me real stats on recurrence. Then again, if I believed stats, I really wouldn't have gotten cancer in the first place.

This is the worst part of this freaking sickness. The fact that the biggest decisions are inherently, MY DECISIONS. I have waited 6 months for someone to say, This is what you HAVE to do." Other than chemo, I've gotten none of that. The initial choice for what kind of surgery was up to me. I chose a lumpectomy because I wanted Maria out NOW. A mastectomy would have meant meeting more doctors, plastic surgeons, yada yada, longer wait. Plus, everyone told me we'd caught it so early, it was so small, etc.etc. Funny enough, we didn't catch it as early as we thought. And it wasn't as small as we thought either.

Most women do not think about going back and getting a mastectomy after getting a lumpectomy. Once you do surgery, you're done. I mean, when they did my surgery, they got clean margins (meaning there was healthy tissue all the way around the tumor... They got it all), so why go back in? I don't have the BRCA gene, my tumor is not overly aggressive- (it's average)...Why do it?

Couple of reasons. First of all, there's a fear of recurrence. A mastectomy does not guarantee anything, but at least if I do get it again, I can say I did everything. Second of all, radiation is a bit scary for me. There is a small chance of a different kind of cancer long time down the road, thanks to the radiation. Good times. Because of my age, it's a slightly bigger risk.

I think no matter what, I will second guess my decision. I don't think I'll ever be comfortable with this process, with what I have to do. It sucks.

Radiation: PROS- less invasive, can start right away, same stats as bigger surgery
CONS- skin problems, treatment is every day for 6 weeks, could clip a bit of heart and lungs meaning risk of other type of cancer.

Mastectomy: PROS- no boobs mean less chance of worries of any little lump or cyst, I would use my own tissue for reconstruction meaning I'd get a great tummy tuck :)
CONS- long, drawn out surgery, time in hospital, couldn't work for a couple of weeks, harder to detect anything else along chest wall, and well, I wouldn't have my boobs.

I can't say I'm overly attached to my boobs. I mean, I didn't make any decisions because my boobs are a part of my identity or anything. They're boobs. One day, I'd like to breast feed my kids...That's about all I care about. And my nipples. I suppose I'm attached to them. Reconstruction means no nipples....at least for a year or so.

So, based on this entry, which way do you think I'm going to go? Surprisingly enough, even to me, I'm doing radiation. All my doctors think it's overkill to do mastectomies. Maybe I was overreacting. And for me, it wasn't about keeping my boobs, it was about not having new doctors, more consultations, more surgeries. Maybe my laziness won out. Not that every single day for 6 weeks is easy.

Maybe I just want it to be done. And maybe I just don't want to go back in for more surgery, feeling all those feelings I felt when I had my first surgery. I don't want any more needles, IVs, operating rooms. I don't want to feel sick. I don't want to "recover" from anything. I want to have my life back albeit minus an hour and half a day of treatment.

So, fuck it, I'm getting radiation. I start today. I've already had pictures and CT scans and permanent marker all over my body. Good times. I'll tell you all about that another time.

1 comment:

Jayne said...

At times,I have struggled mightily with the gravity of this decision making process. Sometimes I think I'm just rolling the dice.

But we are actually making informed decisions so try not to second guess yourself- easier said than done, don't I know!

(I'm realizing that I could go on & on about this so I maybe I'll have to write about the decision theme, too, at some point).