I am an optimist by nature.  It follows then that every year prior to this one, when the clock would strike midnight on New Year’s Eve, I would renew my hope, fill my coffers with positivity and bank on the year ahead of me.  The last few years, I have been happy to see the years wrap up- it’s been a rough road, some rougher than others, but I would step into the new day convincing myself that whatever was ahead would surely be better than what I had just left behind.  This year is a bit strange in that regard.  When 2011 began, I didn’t know what a BRCA gene was, my sister hadn’t found her ‘lump’ yet and all July meant to me was that camping in Yosemite was in the cards.  This year, Missie still has half of her chemo to complete and her radiation.  We both have to fight the weight loss battle for the sake of healthy surgeries yet to come, and I have to be essentially taken apart and rebuilt in the beginning of July.  So this New Year’s I felt myself not resolving to improve my life, but rather resolving to get through it- to stay focused on well-being, to make my body as strong as possible between now and July, and to remain cautiously optimistic that all will be well when 2013 rolls around.  I will hence forth refer to 2012 as the year stumbled through gracefully.

A quick overview of my week of doctor visits- which introduced me to the ‘dream team’ of surgeons, and not just because they are all total babes.  I had already met the breast surgeon, Dr. Foster, who referred me to Dr. Tseng, the Plastic Surgeon and Dr. Karam, the gynecologic Surgeon.  The Plastic Surgeon spent a good hour with me, going over my options but ultimately agreeing with Dr. Foster’s assessment of a bilateral mastectomy and flap reconstruction.  As you may recall, this is the surgery for which one needs to be an optimal weight, so I also started that conversation and I have a good 35-65lbs. to lose prior to July.  I’ve done it before, and although I don’t love the idea of not having food to fall back on in a time of stress, I am very keen to have boobies made of my own tissue- so if choosing between food and boobies, I’ll go for the latter.  I know the peanut gallery agrees.

Then onto Dr. Karam, the gynecologic surgeon, who in fact gave me a lot of information- I’d even go so far as to call it good news- in the midst of this steep learning curve.  He is the first doctor with whom I’ve met who has actually had other patients who have both the BRCA1 and the BRCA2 genes.  He explained that this is most likely due to the fact that he practiced medicine in New York City and at Cedars Sinai in Los Angeles which both have much larger Ashkenazi populations.  That accounts for the high number of BRCA patients.  He said that although having both isn’t ideal- that the percentages are not added on to one another.  In other words, if the BRCA1 leaves me at an 87% risk for breast cancer and the BRCA2 leaves me at a 75% chance risk, that doesn’t mean that I have a 162% chance of getting cancer.  (yeah, maybe I had to use a calculator to add those numbers- shut up).  With that said, he cannot say definitely what my chances are but he would put them about 10% higher than average- which still makes it 97% that I’ll develop breast cancer.  BUT, of course, that’s why I’m opting for the surgery.  And here’s where even more good news comes into play.

Because women have historically had difficulties with hernias post hysterectomy, they began performing them laproscopically.  This way, they do not cut through the muscle and weaken the abdomen.  I had assumed, since they were cutting into my abdomen to take out what I think we should now call my “useful paunch”, that they would just go through the abdomen for all of the surgeries.  But, it turns out that during the flap surgery, they just take the mushy part of the tummy- the “useful paunch”- and they don’t cut into the muscle at all.  So although having both the double mastectomy and hysterectomy all at once seems daunting it isn’t nearly as invasive as I had feared.

The surgery does have a 4-6 week recovery time, but that is actually based on the reconstruction of the breasts, it takes time for them to make a nice new home and evolve from the useful paunch into the perky rack.  Yeah, you heard me, PERKY RACK!  At this point I think the only disagreement that Dr. Tseng and I will have will be about cup size- he’s all about proportions and I’m all about not having to wear a bra if I so desire.   I’ve had one on for the last twenty-nine years, enough already.   We agreed to figure that out once I lose some weight.  I’ll meet with him again 8 weeks before the surgery to assess size etc.  One last cool thing on the boobie front.  It turns out that they have to build nipples and that this is actually done in a separate procedure.  There are two follow up surgeries, one for nipple building- you know you wish you got to write that and say it- and one for making final adjustments and tattooing pigment onto the nipple.  And when this came up- I thought JACKPOT!

I have always wanted a tattoo- so of course because I have no shame or scruples I immediately asked Dr. Tseng if I could get something besides the standard pink pigment.  He was completely nonplussed.  Have I mentioned I love this dude.  He said that the choice of what to have in place of my original breasts is a totally personal one and it can look like and be anything I wish.  This is the first scenario in all of this where I actually felt like I was being given a choice and so I have begun considering what this might look like.   Dr. Karam- the genius gynecologic surgeon suggested one-eyed happy faces.  I have something a bit more subtle in mind- more on that later.

So armed with all of this info. and having begun the process of signing consent forms and blocking out July for recovery purposes- I head into 2012 knowing that it’s going to be difficult.  But recently Missie and I were wrapping presents for the kids of some of her employees and she commented on the fact that neither one of us have ever really wanted for anything.  Yes, we’ve had a rough go of it in the health arena, but really, she said, we’re very lucky.  Totally offhanded- and with absolutely no irony, she referred to us as lucky.  And I thought of that again as she and I ran around Las Vegas last week gambling and hanging out with the family.  I thought about it again as we sat last Thursday seeing the touring production of Wicked with our mom and our Cousin Sarah, laughing and crying and abandoning every sense of cynicism to be enveloped in the pure joy of a big, fat musical.  But mostly we are lucky because we are not sitting around waiting to die.  Waiting for the elusive cancer to come and get us and take us away from all of this luck.  I have known healthy people who seem to spend their lives waiting to die- I’d much rather be “healthy challenged” (I don’t care for the word sick) and enjoy the hell out of everything.  So while 2012 may not be easy- based on Missie’s assessment, I’m thinking it may be lucky.

Happy New Year to all.  Wishing you happiness, love, good health and good luck in the coming year.