Once again, I’m going to start my blog entry by thanking people. My friend Kaleb has been helping me in many ways, not least of which is by setting up a donation site for my care. Since some of you asked for the link to donate, here it is.

If you feel inclined to help out financially and can afford it, thank you for that. If you’ve already done that, I’m so grateful. And regardless, thanks for the emotional support, the offers of food, the driving, the organizing, and the friendship.

Yesterday I took time out from not grading my students’ papers to go to Atlanta for a consult with another surgeon and a plastic surgeon. My excellent friend Clare Schexnyder has recently been through this process and did lots of good research on doctors there, so I was able to just show up. And by just show up, I mean that I brought Kaleb along not only for emotional support and note taking but in one case to be exhibit A, and that I drafted my friend Ken to drive us because, when I get to information overload, I fall asleep and didn’t want to do that in traffic, and that we all left at zero dark thirty in the pouring rain, and that I dragged Clare out of her house to help me think of questions to ask these doctors. I brought along the slides pulled together by Breast Navigator Carol–amazingly supportive despite the fact that I was getting opinions outside of the local medical network–and pathology reports, and a big-pink leaflet-choked breast binder, and 4000 pages of forms, and my insurance information, and my Star Trek checkbook.

I had been pretty sold on the bilateral mastectomy, so I expected to go just so I could say I’d heard everything. However, I saw more photos of mastectomy scars in the doctor’s office. When you see these online, you often see lean, fit women who look pretty gorgeous and have some outstanding tattoos. You don’t often see pictures of plump women, for whom the effect is a bit different and for me a little depressing. Tattoos definitely help, but still, argghh! The plastic surgeon gave me two reconstruction options besides eventual plastic surgery with implants, which seems to be the main option available where I live. One is oncoplastic reduction, and the other is something called a goldilocks, which is a small breast-mound reconstructed out of fat and excess tissue left over from the breast right after mastectomy, while you sleep! It’s less elaborate that a diep flap, which involves liposuctioning fat from the belly and creating a larger breast out of your own tissue (on the plus side, no implants and less belly fat; on the minus side, bigger breasts), but like the diep flap it would involve a longer recovery. I will spare you even more details than I already just gave you against your will.

The main advantage with a mastectomy plus goldilocks is that I probably wouldn’t need radiation.  The main disadvantage is that the breasts don’t always look that great in the photos I saw if the breasts are like mine–slightly droopy and increasingly wall-eyed–because mastectomy takes all the breast muscle that keeps them at attention, so to speak, and a goldilocks doesn’t add that back. That’s why the traditional thing to do has been to get muscle from elsewhere (butt, thigh, or abdomen, for example), and then stick in an implant. I think implants look sort of amazing, both inside and out. Kaleb was playing with some samples marked “not for resale” on them while we waited for the doctor.

They would be great stress relievers, as they are spongy and symmetrical (one had a substance called “Memory Gel”).  My friends who have them look great. However, the ever-swelling binder has a 16-page set of pros and cons about implants. 15 and ¾ of those pages are disadvantages—and those are pages written by the implant companies! They are filled with paragraphs like this: “As of today, no long-term studies have conclusively linked implants to [autoimmune disorders, hair loss, nose loss, insanity, two-headedness, exploding navel syndrome, spontaneous skin sloughing, carnivorous succubus-hatching, etc]. However, studies are ongoing.” There really do seem to be links between implants and suicide, but no definitive data about whether or not you were suicidal before the implants.

The main advantages of Oncoplastic Reduction, which is where you remove the lump and then reduce the other breast to sort of match it (more on this in a minute), is that you have a less extensive surgery, just one procedure, smaller breasts–thank you, occasionally benevolent Boob Deity–and in some cases, your own nipples. They are great for women like me, whose breasts arrive everywhere 30 minutes before the rest of me, and even the plastic surgeon had one. Disadvantages are that with any lumpectomy you have to have radiation, which is a major hassle (it also shrinks the boob and can’t be repeated; to plan for shrinkage, surgeons make the cancer breast slightly bigger to start with). Oncoplastic reduction looks more like boobs as they exist in nature, but somewhat perkier (again, yay). If you keep either boob or both boobs, you have a slightly greater chance of recurrence, but no worse life expectancy than if you didn’t, because, let’s face it, from now on these boobs are going to get a lot of scrutiny. They are not going to be able to make a move without a note from the doctor. And anyway, it turns out that in most cases, breast cancer recurs not in the boob but somewhere else entirely where you are not looking—so much for those thanks, capricious Boob Deity!

The next trip was to a second breast surgeon (you need a different doctor to take out the tumor than the one who fixes it up afterwards, and if you’re going to get simultaneous mass removal/ mastectomy and reconstructive surgery, you need your doctors to be able to actually collaborate and be in the same facility at the same time). This soft-spoken doctor was very helpful and ultrasounded the lymph nodes; that’s not conclusive, but the fact that mine did not look abnormal in the picture was a hopeful sign. (You never really know what they’ll find until they operate; in my case, I’m thinking a bunch of those wind-up monkeys with tambourines.) She talked to me more about the Onco-dx score, which they learn after surgery and which tells you more about your chance of recurrence but also about whether you will respond well to chemo if you need it.  If I go to Atlanta, which is looking more and more likely, I will need to decide which procedure I need and let both doctors know by Monday so that they can try to get a surgery date. My Sylva date is tentatively May 2 and I don’t want wait much longer, in case I go truly mad or my boob falls off or bursts into flames.

Between doctor visits and aided by the Google maps lady who lives in my phone, I got us horribly lost (Atlanta has both a Collier Rd and a Collier Rd NW, and they are far, far away from each other). We also stopped by to see Veronica Nicholas in rehab from her much more intensive and high-stakes glioblastoma treatment. She looks amazing, thin, and as always, joyous and generous even in the midst of chaos. Since I process cancer this way, not that way, I am awed by her and Karl Nicholas, the original models of grace under pressure. Kaleb took a selfie with a Bernie Sanders look-alike in the background, too.

Thanks again to all of you who’ve written, called, donated, driven, told me your stories, bought me food, made phone calls, and taken over my classes (Pamela Duncan the marvelous despite organizing the lit festival already) while so many of you struggle with crap of your own! I work with great people, and I owe a lot to great friends—and an increasing number of strangers. You are the best part of this process, and I’m lucky to have you all.