So as the title suggests, I have begun juicing.  My friend Young Ji suggested this to me to deal with some of my chronic ailments and I thought, what the hell- nothing else seems to be working at the moment and I still have to lose all of this weight before my surgery in June, I’ll give it a shot.  It is seriously cool.  The juicer itself is like a magical machine that liquifies everything into pure nutrients and although I know there are some who think the juice can taste less like the vegetables from whence it came and more like the dirt they were grown in, I in fact like the taste of the juice.  Today I drank a batch that included brussel sprouts, spinach, carrots, cauliflower, broccoli, ginger, apples, grapes, cucumber and celery and it was pretty damn tasty.  With that said, I am drinking this juice as my breakfast and lunch, so god help you if you are in my path between four and six when hunger for dinner sets in and everyone around me becomes a steak with legs like in the old cartoons.  But I’m doing it, and then trying to stick to primarily protein in the evenings.  My physical therapist was concerned that because I’m working out six days a week and sometimes twice a day that the juice might not be enough calories, but so far it hasn’t seemed to be a problem.  The juicing is also incredibly time-consuming, mostly in terms of prep and clean up but I’m determined to stick with it for a month or so and see how my body responds- I’ll let you know.

In other news, my dad is recovering very well from the removal of his ureter and kidney.  He won’t have to have any follow-up chemo or radiation as far as he’s been told and he was home from the hospital three days after the procedure.  He looks exponentially better each time I see him and his co-workers bought him an AMAZING cake- kidney shaped with one of my dad’s writing lessons scrawled atop the cake “when in doubt, cut it out.”  Hard to top that as a get well gift. The relief that both he and my step mother are experiencing is palpable, while they both insist that they weren’t worried, the feeling that they’ve finally stopped holding their collective breath tells another story.  For the record, we are all breathing a bit easier now that he’s home and healing.

I am nearing the end of the two year clinical trial that I have been on for MS- it’s a bit nerve wracking because its completion dictates my surgery date so the shipment of my last batch of meds gave me pause.  May 28th will be my final day on the trial at which point they will ween me off of the trial meds- a pregnancy level dose of Estriol with a bit of progestin thrown in for good measure, and once it clears my system I am good to go for surgery- hence the date at the end of June.  This also means that I am counting down to the last period I will ever have.  If there is a silver lining folks, that is surely it.    Almost thirty years of this shit- it will not be missed in the slightest.

I think it’s safe to say that I don’t think about the surgery in the most concrete of terms.  I think about things like what state I’ll be in for my son to come and see me.  I think about who I will be comfortable having in my proximity once the procedure has been completed.  I don’t think about the pain or the changes to my body or even the cancers that I can’t address with these procedures.  With most of the other cancers, I can’t even get a true sense of what my odds are of developing them because the statistics never include both BRCA1 and BRCA2.  It isn’t that I’m in denial about any or all of these things, it’s just not where my mind leads me when I begin to think about the approaching date.  It is probably my built in ‘deny’ switch that has simply engaged on its own accord and intends to stay switched on until it is absolutely necessary that I switch to ‘reality’ mode and face the fear.  Maybe I’ll get lucky and stay in denial, but that has it’s own pitfalls.

For instance, besides eating, all I can think about is shopping, reading escapist novels and making out for hours on with men who are either unavailable or uninterested.  While relatively harmless pastimes, with the exception of the eating, I do feel a bit like a silly teenage as I drift into kissing fantasies briskly followed by sharing cake with said kisser.  So sad, I can’t even be sexy and smooth in my own fantasies- I require a made-up man who appreciates my smart ass sense of humor and my love of chocolate.  What- am I asking too much?  It’s my damn fantasy- and god knows, I’m entitled to tailor make it considering the real thing (meaning my life) certainly hasn’t turned out as I planned.  But I realize, because I’ve had enough therapy to do so, that the shopping and the eating and yes, even the kissing are all the barriers I’m building to avoid what is coming down the pike.  This surgery is big, and it’s long and I’m afraid of what my MS will have to say about it when all is said and done.  Either that or I really just like making out.

But for now, I’ll stick with the escapist novels.  I’m currently wrapped up in a trilogy about a family publishing house in England in the first part of the 20th century.  It doesn’t erase what has to be faced, but it sure makes it all go down easier.

My best friend asked me some questions about my procedure, so I thought I’d throw down some hardcore medical literature this morning.  This article covers my DIEP flap procedure.  Please note, what isn’t explained here is nipple reconstruction which as I understand it can be done in my plastic surgeon’s office in two follow up outpatient procedures.  More on that to follow after I verify it with Dr. Tseng, my plastic surgeon.  Also, this talks about an 8 hour procedure but that doesn’t account for the hysterectomy part of the surgery, so it may be more like 9-10 hours, more on that to follow as well.  This is the best description of the surgery I could find, I found it very helpful in spelling out the micro part of the surgery which is crucial to the success of the entire procedure.  I just need to keep telling myself that knowledge is power!  Happy Monday.

Taken from http://www.breastcancer.org/treatment/surgery/reconstruction/types/diep.jsp

DIEP stands for deep inferior epigastric perforator. This is the name of the main blood vessel that runs through the tissue that will be used to reconstruct the breast. In DIEP flap reconstruction, only skin, fat, and blood vessels are removed from the lower belly (the abdomen between the waist and hips). No muscle is removed. This is one of the main differences between the DIEP flap and the TRAM flap–the TRAM flap procedure removes muscle (along with fat, skin and blood vessels) and the DIEP procedure does not.

Because no abdominal muscle is removed, most women recover more quickly from DIEP compared to TRAM and have a lower risk of losing abdominal muscle strength. There also tends to be less abdominal wall discomfort because your muscle isn’t involved.

The other main difference between the DIEP and TRAM procedures is how blood is supplied to the belly tissue once it becomes your new breast. The DIEP is a called a “free” flap because the tissue is completely detached from the belly and then reattached to the chest area. Hooking up the blood vessels from the belly tissue to chest blood vessels is delicate work. Your doctor has to use a microscope during surgery, which is why DIEP is known as microsurgery. The TRAM procedure doesn’t detach the belly tissue from the blood vessels in the belly. The belly tissue, still attached to its belly blood supply, is moved up to the chest area. No blood vessel surgery is necessary. Because of the extra time required for the blood vessel microsurgery, DIEP flap surgery takes longer than TRAM flap surgery (about 5 hours to reconstruct one breast and up to 8 hours if you’re having both breasts reconstructed).

Like the TRAM flap, you end up with a tummy tuck as a fringe benefit of DIEP surgery because fat from your abdomen is removed to reconstruct your breast and loose skin is tightened up.

Breast reconstruction using your own tissue is popular because it’s a long-lasting solution (implants usually have to be replaced after about 10 to 15 years) and the consistency of the belly tissue is very similar to natural breast tissue. But the new breast will have little, if any, sensation.

DIEP has been used since the early 1990s. Because the surgery is more complicated, it’s not offered everywhere. It’s usually done by plastic surgeons who specialize in free flap breast microsurgery. If you’re interested in DIEP, ask your breast cancer surgeon for recommendations.

The DIEP flap procedure isn’t for everyone. It’s a good choice for women who have enough tissue to reconstruct one or both breasts. In general, you can still have DIEP if you’ve had abdominal surgery (hysterectomy, c-section, appendectomy, bowel resection, liposuction, tummy tuck).

DIEP is NOT a good choice for:

• thin women who have very little abdominal fat to spare
• women who smoke and have blood vessels that are narrow and less flexible

How does DIEP work?

A small incision along the bikini line is made and the necessary skin, fat, and tiny blood vessels are removed. The fat and skin are shaped into a natural looking breast and sewn into place. The tiny blood vessels that feed the tissue of your new breast are matched to supplying vessels in your chest and reattached under a microscope. The procedure takes about 5 hours. Compared to women who have had TRAM flap surgery, women who have had DIEP reported less pain and more abdominal strength after surgery. But DIEP is still major surgery and you should expect to spend about 4 weeks recovering.

DIEP for double mastectomy

DIEP reconstruction can be performed after a double mastectomy, provided you have enough extra abdominal fat. Your surgeon will determine if there’s enough tissue to do both breasts. This surgery takes longer than a single reconstruction (about 8 hours).

Okay, so while the pre-surgery diet is not exactly on schedule, the pre-surgery workout regiment has been kicked into high gear.  I have officially become the crazy lady dancing around her living room.  I have continually told my physical therapist that I intend to do thirty minutes of cardio everyday to help kick up my metabolism.  Well, walking a seventeen year old dog, while very pleasant, was not getting the old heart rate up so I invested in a game for my wii- Just Dance 3.  Now, for those who have never played the wii, you hold a remote in your hand and a sensor bar tracks your action.  With the dance moves, it is VERY particular how your move that arm and you get scored on each move.  There is an added feature called ‘just sweat’ where the system will choose high energy songs and count your calorie burn and I have managed to burn about 2000 calories each time I fling myself around the living room.

Now, for those of you who are like me and think that working out basically blows, I am directing this at you.  For those of my friends who love their morning run, or morning yoga, or morning whatever, you can skip ahead to the next paragraph.  Okay, lazy asses like me- here is what rules about this exercise.  First, I can wear anything.  Black bra, white t-shirt?  Who cares, I’m in my living room.  Total panty line under the most unflattering, here are my thunder thighs leggings?  What, you think the dogs are judging me?  And even if they are- they can’t talk so fuck ’em.  My point it, I fling on whatever is closest, and I dance around like a silly spaz, which I fear is an insult to people who actually suffer from spasticity, and here’s the kicker- I smile and laugh through my entire workout- whilst sweating my ass of, literally, and burning up to 2000 calories.  If I can keep this up until the end of June, I may not be thin for surgery, but I’ll certainly be heading into the operating room in good physical condition.

I am still continuing with yoga, pilates and pool workouts as well, much of which focus on weight training and muscle building so if you laugh at me dancing around my living room, I can totally kick your ass.

An update on my dad, and thanks to all of you who have emailed and asked after him.  He’s still waiting on surgery, but they are hopeful that much of it will be done laprascopically (sp?) and as I understand it, there is also a robot involved in the procedure which is pretty freakin’ cool.  But apparently, the hospital only has one of these robots, hence the waiting time.  I’ll update everyone when he is engaged in his speedy recovery- he doesn’t piss fart around with these things, he’s keen to start lapping the ‘old’ people in the halls of the hospital.

In nipple news, my friend Cara has graciously begun the design process for my new tattoos- she has, of course, already solved some design flaws- with the tattoos- not the nipples- and she is going to try and have a revised design for me when I meet with my plastic surgeon and breast surgeon in the beginning of May.  Although I am fairly married to the quote I have chosen for the tattoo- I thought it would be fun to make a contest out of it- whoever comes up with the best quote for my nipple tattoos gets a prize- I’m not sure what that is yet, but I promise to think of something great- maybe Just Dance 3!!

Last week I had to start telling colleagues that I am going on leave this summer for two months and that has been rather strange.  We’ve hit the point though where we are scheduling play readings of commissioned works and while normally I am present for any and all of these readings, I am simply going to have to miss some.  Just as I am going to have to miss our annual trip to Yosemite with the Cohen-Roberts clan, and the 50 mile MS walk that I try to do every year, and various other events that I look forward to with great anticipation.  Instead, I am grateful that I have enough vacation time and sick time saved up, from missing all of these much beloved events, that I can take two months off of work and it will not be a financial hardship.  And I know in the long run I am giving myself the possibility of a lot more of these trips in the future, by limiting my risk of cancer, but try explaining that to an eight year old.  Shit, try explaining it to a 40 year old.

The last topic, not nearly as fun as the living room dance tid bit- I did start putting my will together and I have to make decisions about who is going to hold my durable power of attorney and manage my advanced directives.  This is a tough call.  The way I see it, parents aren’t supposed to have to deal with these things with their children, that’s nature looking backward and I hate the idea of any of my four parents (that includes two steps who have always treated me as their own) having to make decisions on my behalf.  My sister seems the obvious choice but the nature of the responsibility is more than I want to ask of her in a year when she has had to examine her own mortality.  So I suppose I will just put everything in writing, as clearly as possible, and hope that these documents will be nothing more than filed papers, of little use for at least another 50 years or so.  By the way- who knew you could create a will on line for 69.00 bucks- which mind you is probably more than the value of all of my possessions.  But this is what grown ups do- we make wills to protect our children, we create advanced directives to protect our loved ones from impossible decisions, and if we are lucky, we dance around our living rooms experiencing inexplicable joy in the midst of all of life’s curve-balls.