Abiding
This is a longer post that includes some of the details of my upcoming surgery, so I'm breaking it up for you to read according to your time constraints (no judgment!).
Bottom line: This was a good week off. Rest weeks encourage me that at some point I will feel more "normal" again. And Anthony had a wonderful birthday on Friday! We had a good meeting with my plastic surgeon (details below). My infected toe is healing with antibiotics. My liver numbers came down a little but still remain elevated. This is disappointing but not shocking - recurrence with (immuno) therapy-induced hepatitis is common. It will most likely mean that I will stay on steroids (prednisone) for a while. Please continue to pray against permanent liver damage and that steroids will not be ongoing. My last Taxol/Carbo infusion is this Monday. And my new harder) chemo regimen (AC) will start the following Monday (Lord willing). I'm nervous about starting this new round simply because I don't know what to expect. But I know God will give me what I need when I need it.
As treatment progresses, surgery approaches. As you can imagine, evaluating surgical options is overwhelming and intimidating. As one surgeon told us in this process, "You are being forced to choose between terrible options!" Every option is less than ideal (compared to a healthy human body) and has its pros and cons. After much consideration and prayer, I am planning on a bilateral mastectomy with implant reconstruction.
For those interested in more details: Here are my surgical options in layman's terms and how I came to my decision...
Options to remove the cancer (performed by breast surgeon Dr. Delach at Jefferson):
Lumpectomy: Only removing the cancerous lump/portion but leaving the rest of the breast intact.
Unilateral mastectomy: Removing all the tissue in the one breast affected by cancer.
Bilateral mastectomy: Removing all the tissue in both breasts.
Options for reconstruction after a mastectomy (performed by plastic surgeon Dr. Patel at Fox Chase):
No reconstruction: Remaining "flat."
Implants: Silicone shells placed into the breast to give it shape.
DIEP Flap: Taking fat tissue and skin from the belly and transferring it to the breasts. (DIEP stands for Deep Inferior Epigastric Perforator)
I've been weighing and praying about these options for months since the start of this journey. Remarkably, I have friends who have opted for every one of these surgery types. So I have asked many questions... the pros and cons, how they came to their decision, what recovery looked like, whether they would make the same choice again, etc. And ultimately, I have found that it is a very personal decision based on numerous factors. Each woman's situation is so different, and we are all just trying to make the best choice with the information, circumstances, and body we've been given. Lord help!
We initially met with Dr. Delach at my diagnosis to talk about surgical options, and we will meet with her again soon to talk through specifics. I have decided on the double (bilateral) mastectomy (as opposed to a lumpectomy) because Triple Negative Breast Cancer (TNBC) is known to be recurring, and I want to minimize, as much as I can, any opportunity for it (or any other type of breast cancer) to return. If I opted for a lumpectomy, I would be getting scans every six months ongoing (alternating between MRI and mammogram/ultrasound), and I prefer to avoid that.
We had a helpful, informative meeting with Dr. Patel this week. He was wonderful. He thoroughly and patiently walked us through the process for each reconstruction option, answering all of our questions. I teared up thanking him for what he does, and for making this difficult process easier through his skill and unhurried, knowledgeable explanation.
I was seriously considering the DIEP Flap option, because I would prefer to stick with my natural tissue. Even though I knew this was a harder surgery, it felt worth it in the long run. But after the doctor's assessment, I don't have enough belly tissue to create a satisfactory result. And for such an intense surgery and recovery, I don't feel it would be the hoped-for outcome in the end. So I am opting for implants.
Both surgeons will be in the operating room during surgery. Dr. Delach will perform the mastectomy, and Dr. Patel will follow with reconstruction. It would be nice if both could be done during the same surgery (this is called "direct to implant"). This will be a decision made by Dr. Patel in the OR. If my skin looks like it can handle implants immediately, he will place them right away. But if my skin is too damaged and needs time to recover, expanders will be placed instead, and implant reconstruction will be delayed for another later surgery. I'm open to either option. While it would be nice to have a single surgery, I also don't want complications (which can happen if you rush too soon to implants). I trust Dr. Patel's discernment to know what is best in the moment. This is something we can pray for!
On a heart level, a lot of scripture has been coinciding for me lately from different angles (love when that happens :)...
As I've posted in recent updates, I've been living in Psalm 131, particularly verse 2: "I have calmed and quieted my soul, like a weaned child with its mother; like a weaned child is my soul within me." A weaned child is not looking to be fed. A weaned child simply wants to be with their mother, enjoying the safety and contentment of knowing they are taken care of. There is a rest that comes when I remember that Someone more equipped and capable is tending to all of the things that are "too great" for me. And boy, there are a lot of things too great for me right now.
Along these same lines, I've been thinking a lot about "abiding." Anthony recently preached three sermons on John 15 (You can listen here: Part 1, Part 2, Part 3) and I've been strengthened as this chapter has
"simmered" in my head and heart, particularly verses 4-5:
Abide in me [Jesus], and I in you. As the branch cannot bear fruit by itself, unless it abides in the vine, neither can you, unless you abide in me.
I [Jesus] am the vine; you are the branches. Whoever abides in me and I in him, he it is that bears much fruit, for apart from me you can do nothing.
To abide means to remain, continue, stay, dwell, reside. I am to make my home with Jesus Christ. To settle in with him, continue on with him, looking to him for everything, enjoying him. But not only am I abiding in Christ.
It says (twice) that he is abiding (living, staying, dwelling) in me! What a comfort! Even when I am wavering on my end of the bargain, he will never be unfaithful to me (2 Timothy 2:13-"If we are faithless, he remains faithful"). He is abiding to stay.
He is the vine, the source of nutrients and growth that leads to fruitfulness. I am the branch, an extension of the vine, and in his design, a pivotal part. Apart from him, I can do nothing. I am dependent on him for even my next breath. With him, connected to him, I have fullness, fruitfulness, and vibrant beauty. "Like a tree planted by streams of water that yields its fruit in its season, and its leaf does not wither" — from Psalm 1 (verse 3), another psalm that has been so rich to me.
(I've recently started reading a wonderful book by one of my favorite theologians, Dale Ralph Davis, called The way of the Righteous in the Muck of Life: Psalms 1-12).
As I was on a walk with the dog this week, I listened to a song called
"Abide," and couldn't stop the tears from flowing as it put these rich truths to music. Something about music hits our souls in a uniquely moving way, doesn't it? Below are the lyrics, and you can listen here. Yes, Lord, please teach me to abide in you:
Abide (by Christy Nockels)
For my waking breath. For my daily bread. I depend on You. I depend on You
For the sun to rise. For my sleep at night. I depend on You. I depend on You
You're the way, the truth, and the life. You're the well that never runs dry. I'm the branch and You are the vine. Draw me close and teach me to abide
Where the Spirit leads. As I'm following. I depend on You. I depend on You
For the victories. Still in front of me. Oh I depend on You. Yes I depend on You
Be my strength, my song in the night. Be my all, my treasure, my prize.
I am Yours, forever You re mine. Draw me close and teach me to abide
When I pass through death. As I enter rest. Oh I depend on You. Yes I depend on You
For eternal life. To be raised with Christ. Oh I depend on You. Jesus I depend on You
You're the way, the truth, and the life. You're the well that never runs dry. I'm the branch and You are the vine. Draw me close and teach me to abide
Prayer:
That I will have no permanent liver damage or neuropathy, nor a need to stay on meds for these issues long term.
That I will be able to proceed with my last Taxol/Carbo treatment this week followed by my new harder chemo the following week.
For endurance through my final two months of chemo and for manageable side effects.