Treatment Timeline

 I thought it would be helpful (for myself and others) to write up my treatment timeline. 

June 2019 - went to primary care doctor because I felt a lump

6/24/2019 - Ultrasound

7/1/2019 - Biopsy

7/9/2019 - Diagnosed with cancer

7/17/2019 - Met with surgeon (and oncologist later that week)

7/24/2019 - another biopsy, imaging, genetic testing

8/5/2019 - appointments with radiologist, genetic testing followup, EKG, etc. 

8/16/2019 - appt with second opinion onc. at Dana Farber (recommended by my oncologist)

8/20/2019 - original port placement appointment, but I rescheduled it to the day before chemo

8/27/2019 - port placement

8/28/2019 - 10/9/2019 - AC chemo every two weeks (4 total)

10/30/2019 - 1/16/2020 - Taxol chemo with herceptin / perjeta (12 total)

2/26/2020 - double mastectomy

5/30/2020 - 9/24/2020 - Capecitabine pills (Xeloda)

9/23/2020 - last Herceptin infusion (had every three weeks for 1 year)

10/20/2020 - saplingo-oopherectomy and implant exchange

2/12/2021 - fat grafting

10/1/2021 - nipple reconstruction

Fat Grafting Surgery

A week ago I had fat grafting surgery (taking fat from places on my body to give my implants a more natural appearance) as well as a small revision (lifting one side). I have over the muscle implants and the rippling honestly wasn't bothering me that much, but my surgeon recommended it, especially since I wanted to have nipple reconstruction - she said she would need somewhere to work with, the skin without fat grafting was just too thin.

I thought this is going to be a pretty quick surgery but it ended up being pretty long and involved. I think the surgeon was running a bit late, so I arrived at 8:30 for a 10:00 surgery but was waiting in the OR prep until well after 11:00 as everyone else came and went. The surgery itself must have taken about 2 hours, and I thought I was going to be in recovery for about 45 minutes, but it ended up being much longer - my ride was told to get there around 4:00. 8:30 -4 in the hospital is not what I expected for a small surgery! 

But other than that, recovery was very easy. I have to wear a waist binder. Some fat was also taken from my legs and I wish someone would have told me to wear some Spanx because I think that would have helped with a bruising - The bruises on my legs are larger than my head! But I barely needed Tylenol - I took it for 2 days and kept on forgetting because I really wasn't that uncomfortable.  It would have been really easy if my surgery wasn't on a Friday and I didn't have to chase after a 3-year-old all weekend! 

My paperwork said not to shower but my surgeon said that I could - I took a couple of shower so far and just tried not to get my breasts too wet. I'm also not wearing a bra which seems to be her recommendation after any surgery. I find it surprising how much this varies, some people have to wear a bra!

The surgeon was right, my breasts look so much more natural now! I'm seeing her on Monday and looking forward to getting bandages off if it's not too early.

Some Favorite Veggie Recipes

In my quest to eat the rainbow, here are three of my favorite veggie-heavy recipes from the last year. I have made these over and over! 

Beet Dip from the New York Times. It's basically raw beets, walnuts, lemon juice, a pinch of chili flakes, and lots of olive oil. I love this because sometimes I'm too lazy to roast beets. This is totally delicious and tastes like more than the sum of its parts. I haven't served it with the suggested labneh, I just dip vegetables in it. 

Big Flavor Broccoli from Bon Appetit. I especially love that this recipe uses the stems of broccoli because I had been getting long-stemmed broccoli from Imperfect Foods. Not that broccoli stems are complicated to add to a recipe, but I needed the extra encouragement. This recipe gets its deep flavor from anchovies and a squeeze of lemon.

Oven Baked Vegetarian Tofu Parmigiana from Mom's Kitchen Handbook. I bake this for much less time than suggested, making it a good weeknight meal. My 3 year old loves helping.

Growing Broccoli Sprouts at Home

Cruciferous vegetables are always recommended for anti-cancer diets, and I try to eat them a few times a week (I also love them!). Sulforaphane is one of the compounds that's especially prized for its effect against breast cancer, seen in both test-tube and population studies. 

Broccoli is the most sulforaphane-rich veggie, and...broccoli SPROUTS have 100x as much sulforaphane as grown-up broccoli! Even better, they are super easy to grow at home.

Here's how I do it:

I bought these sprouting lids which screw on to large mason jars, as well as this pound of seed mix which contains broccoli, alfalfa, radish and clover seeds. I'm sure there are lots of options out there, I liked that this was from the USA, non-GMO and organic. 

1. At night, I put 1 heaping tablespoon of seed mix in a large mason jar, cover liberally with water, and screw on a lid. I leave it upright in a cabinet overnight.
2. The next morning, I drain the water (through the holes in the lid) and rinse. I place it tilted upside down in a glass food storage dish so the water can drain. I keep it in a dark cabinet.
3. For the next 2-3 days, I rinse and drain the seeds about 3 times a day, returning to the dark cabinet.
4. When the sprouts are about 3/4 inch long, I move them to a counter so they can get some light and turn green. I continue rinsing for a day.
5. Then I remove the sprouts with a clean fork and put them on a paper towel in a shallow container in the fridge.

If you would like more detailed instructions, check out Clean Eating Kitchen!  

I read that sprouts are most powerful when eaten between around 120 - 140 degrees F, so it's good to heat them a little but not too much. I think it's better to eat them cold than overheat them. 

I used two tablespoons here - crowded!

Port Removal

I had my last Herceptin a week ago, so today I had my port removed! I decided to do it with local anesthesia (lidocaine) instead of getting knocked out. I didn't have to fast and I was out of the hospital faster. 

It didn't hurt - the shots felt similar to when they access my port. Then, I just felt a lot of tugging but no pain.

Early Menopause after Saplingo-Oopherectomy and HRT Talk

It's been almost a month since my saplingo-oopherectomy (preventative because of BRCA1) and I'm very lucky - I am feeling minimal symptoms! I haven't had any hot flashes, which is a surprise because I had them during chemo. 

My biggest symptom has been fatigue - all of a sudden during the day I would get so tired that I could hardly get up from my chair. But that's been getting better, and I wonder if it's also related to stopping cardio exercise for surgery recovery - I'm only starting to get back into it now. I was happy to see that I still have a sex drive and some lubrication, but I noticed some pain during sex, like there is a little less lubrication than before.

Before my ovary removal, I was SO eager to find out whether HRT was an option for me. I heard horror stories about having 30 hot flashes a day and not being able to sleep, and that the symptoms would occur immediately after surgery. I was panicked that my menopause-related appointments were a month after surgery. Those appointments were today and luckily I'm doing OK.

When I was researching HRT options, I became curious about Duavee, which pairs estrogen with bazedoxifene. The bazedoxifene essentially keeps the estrogen out of breast and uterine tissues. This recent study shows it not only treats menopausal symptoms, but also has a positive effect on breast cancer risk biomarkers. It's totally not meant for women who have had breast cancer, but it seems like a promising possibility - at this point, I'll just see what my doctors say and follow any future trials. Because I'm not experiencing bad menopause symptoms, I am not as eager to jump into something that has risks and side effects of its own, but I'm still curious what my options are. 

Does a Double Mastectomy Hurt?

Before a surgery, it's easy to feel frightened by the unknown. Will it hurt after? How much? I know it's different for everyone but I thought it would be helpful to share my experience.

I had a double mastectomy with prepectoral expanders placed - this means that they are over the muscle. I believe this is somewhat less painful than under the muscle reconstruction because you do not need to cut the muscle. I had one lymph node removed.

When I woke up from surgery, I was sore, but I did not feel any sharp pains. I thought the pain medication from the surgery would wear off and I would be in a lot of pain, but that didn't exactly happen. 

Because of the mastectomy, I did not have any nerve endings in the front of my breasts. Because of that, the cuts / stitches on my breasts never hurt. Occasionally I would feel slight discomfort deeper in my breasts where the tissue was removed, but it wasn't sharp pain. 

The parts that were most uncomfortable for me were the drain sites (I had three drains total - two on one side and one on the other). These felt a little bit pinchy and annoying, but not deeply painful. Also, especially at first, the lymph node removal site was sore. I was lucky to only have one lymph node removed. I found that ice made it feel better - I left the hospital with an ice pack and used one for a few days after intermittently.

However, I was able to recover from the double mastectomy with only over-the-counter pain medications (mostly Tylenol and some ibuprofen). I took these for a couple of weeks, and in the end just at night. I wasn't interested in taking any heavier pain medication because I didn't feel like the pain was all consuming - It was localized and just annoying. Mostly, the fear of pain (like, will the seatbelt press on my breasts and make them hurt?) was worse than any actual pain.

How does this compare with an exchange surgery? Well, I just had my exchange surgery and it was even less painful. In fact, I never felt any pain in my breast area. This is what made me think about how the drain site and the lymph node were the source of most of my pain the first time. For the exchange surgery, I also just took some Tylenol and ibuprofen. (I also had my ovaries and fallopian tubes removed at the same time and that was the slightly more uncomfortable area, so I don't know if I would have even needed much for the breasts).

if you're about to have surgery, I hope it's helpful to read this! I know everyone is different and some people do experience a lot of pain after surgery, especially if they are having under the muscle reconstruction. But it's always good to read about the best case scenario, and I was so surprised how little pain was involved in the surgery. In fact, I found recovery from childbirth to be much more challenging!

Good Habits I Formed During Cancer Treatment

I know, finding a bright side of cancer treatment sounds so forced, but today I realized that treatment did help me develop some good habits:

1. Consistently drinking lots of water - I always drank a lot of water, but keeping track of my intake during chemo (I tried for 90-100oz / day) made me more aware of how much I drink, and I find myself staying even more hydrated than before.
2. Wearing gloves to do dishes / clean - In the past I knew I should wear gloves but avoided doing so. During chemo, when my hands and feet were very sensitive and had tiny cuts, I didn't have a choice. Now my hands are better but I can't imagine doing dishes without gloves! These are my favorite dish gloves.
3. Moisturizing my hands and feet 
4. Exercising - I'm a fairly active person, but mostly tended to walk with only occasional cardio. During chemo I tried to sweat as much as possible and got on my exercise bike whenever I could, even for an easy ride. After ending treatment, I now look at working out as a treat and look forward to it. I usually do a short (20-30 minute) cardio workout at least 5 days a week, a quick yoga routine daily (between 5 and 20 minutes) and walk a lot every day (it's rare that I don't hit 10,000 steps). Also, I started looking at movement as a non-negotiable part of the day. I sneak in a workout between meetings or during naptime. 
5. Thinking of food as medicine - Whether it's broccoli sprouts, green tea, cauliflower, mushrooms, olive oil, or berries, I am excited to eat cancer-fighting food. I try to work more vegetables into my diet and make sure I'm eating a variety.
6. Drinking less alcohol - This wasn't intentional, but during chemo I lost interest in drinking, and now I have maybe one drink every two weeks. I don't miss it. If I drink I try to stick with red wine, both because I love it and because it has the most cancer-fighting resveratrol (especially pinot noir).

Healthy Whole Wheat Banana Pancakes

This is one of my go-to recipes that's healthy and delicious - all whole grain with no added sugar (I leave out the maple syrup and it's sweet enough). My 2 year old loves to help make these! 

The original recipe is here: Whole Wheat Banana Pancakes

Or you can check out my own adapted drawing of the recipe in this post. I usually use almond milk and you can sub butter for coconut oil or another non-dairy option.

 

Exchange Surgery and Oophorectomy

Yesterday was my exchange surgery and salpingo-oophorectomy! I feel fine and am managing pain with over the counter medicine (Tylenol and Ibprofun). The most pain is getting up from bed and when I laugh. But I was able to go for two long walks and get over 10,000 steps already today, so I'm pleasantly surprised.

The surgery was fairly uneventful. The most annoying part was trying to find a vein - my "good vein" arm is off limits due to lymph node removal. So I got repoked in all these places that were bruised from my last unsuccessful blood draw until they gave up and used my hand instead. But overall, can't complain 😂

My Next Surgery

On Tuesday I'm going to have my next surgery, my implant exchange and salpingo-oophorectomy (removal of ovaries and fallopian tubes). 

I'm sure it's partly because of covid-19, but I've had to do so much to even get this scheduled! It took about 20+ phone calls to both surgical teams to even get them to coordinate and get on the schedule. I started calling at least 3 months ago! I was told it would probably be November or December, and then I got a surprise date in October, and then that got rescheduled and the hospital moved.

I've had to ask for everything proactively - Do I need a blood test? A covid test? to wash myself with that funky stuff in the shower that you use before surgery? It turns out that yes, I did, and it all seemed very last minute even though I kept on asking.

I'm saying this not to complain but because I realize the challenges facing those of us being treated for cancer or any other major condition. We really have to advocate for ourselves in order to get everything lined up! It's a lot of work, especially for people who are not feeling great, mentally or physically. (Luckily I am)

Eating the Rainbow to Fight Cancer

I've made small changes to my diet since diagnosis, and one is to eat an even wider variety of vegetables. 

I love this video from the Zakim Center's nutritionist (I also wrote about her video Does Sugar Feed Cancer). She makes the challenge of eating a variety of vegetables seem easier by breaking them into color groups. 

Vegetables have phytonutrients - basically the plant's own immune system - and the more colors you eat, the more variety of beneficial phytonutrients you get. 

What colors of fruit and vegetables did I eat today?

It was fun to think about my day of food and color code. I could have used a bit more red and white foods. I did have radishes in the fridge. But overall, pretty good.

• Breakfast - a slice of bread with almond butter and fruit
• Blackberries
• Blueberries
• Almond butter (she mentions nuts in the video too)
• Snacks
• Banana
• Peanut butter
• Dried apricots
• Dark chocolate (she doesn't mention this, but it has flavonoids!)
• Lunch - veggie & dip snack, homemade vegetarian lentil/sweet potato empanada, salad
• Snap peas
• Beet dip (love this recipe!)
• Sweet potatoes (in an empanada)
  
• Lentils - she didn't mention these but they do have phytonutrients too
• Date
• Lettuce
• Dinner - cabbage orange slaw, vegan hot dog with sprouted bun, steamed broccoli
• Purple cabbage
• Oranges
• Raisins
• Walnuts
• Broccoli

Does Herceptin have side effects?

A part of one of my tumors was HER2+, and the rest were triple negative. Because I had some HER2+, Herceptin is part of my regimen. I had Herceptin infusions every 3 weeks during my neoadjuvant (pre-surgery) chemo, and continue to have them every three weeks for a year. 

A lot of people are nervous when they find out they have to have Herceptin infusions for a YEAR. I was too! But I'm here to report that, at least for me and most other people, it has no side effects. When I received it with other chemo, I wasn't sure. But now that I'm just getting Herceptin by itself, I can assure you it's easy! 

Here's what happens: I go in to the infusion suite every three weeks. The first time I went after surgery, my infusion was over a longer period, about 90 minutes. This is to check for an allergic reaction. After that infusion, the rest have been over a period of 30 minutes. The nurse takes my blood pressure and temperature, flushes my port, hooks me up to fluids, and then the Herceptin. I'm usually in and out in an hour or less. Unlike AC/Taxol chemo, I don't have to get steroids or benadryl, so I can drive myself.

Thought that might be reassuring to those of you finding out you need Herceptin over a longer period of time.