Update: That Other Shoe That Dropped

June 2013 brought me the "thud",  the "other shoe that dropped"......for those of you who have not seen my that July 21, 2013 post, it was all about the surgery I needed due to Tamoxifen side effects.
The short re-cap goes like this:
June 28, 2013, I had surgery to remove my left ovary and left fallopian tube (with the caveat that if anything biopsied during this surgery was cancerous, I would have a complete hysterectomy).  I woke up with the left ovary, left fallopian and the right fallopian tube gone. Thankfully I had managed to hold on to my right ovary and uterus because there was no cancer found in the biopsies that were done during the surgery.

Two weeks after the surgery, I had the typical surgical follow-up appointment and then six months later I had a regular gyn exam with all the usual tests. During this six-month appointment, I mentioned to my obgyn that I was having pain (which ranged from short and tolerable to sharp, shooting and repeating pain) on my right side in the ovary zone.
Now, as you can imagine, I keep notes - with dates, details, descriptions -  as I am now even more sensitive to whatever it is that I perceive as a change in my body....or something that just does not seem right. 
My obgyn heard all my concerns and notes and recommended a "date with the ultrasound wand".

On February 24, 2014, I went back to the hospital radiology department (a place I already felt I was too familiar with) for the internal vaginal ultrasound. So there I was, clothes on my top half, paper "blanket" on my bottom half and my fabulous patterned knee-socks as I lay there in a rather vulnerable position. I was nervous and switched between moments of concentrated quiet breathing to talking incessantly to the radiology tech. The tech was doing her job and I was watching her face like it was a poker tournament and she had a tell and a pile of poker chips.

In my head I started a silent chant...."save the right ovary, the only ovary, save the right ovary, the only ovary". Oh, and in case you were wondering, it is very difficult to relax and let someone insert that ultrasound wand and do their job. After it was over, the waiting game began - there is this part of you that wants to know the answer/result, but there is also that part that would rather not know the findings.

A couple of days later I learned that the right ovary had a cyst and that at this point it appeared to be a typical cyst that would resolve on its own. I was told to keep tracking any pain that I felt and that I'd need another date with the ultrasound wand in six months. Then my obgyn says that if the pain changes, continues or is not in line with "girl math" (aka  the halfway point of my period), I will need to have another ultrasound sooner than the six-month date.

I am sure that there are people out there that would have said "take it all" on the June 2013 surgery date and just be done with it, but I am not one of those people. I know there is a chance that I could end up having surgery again and having the right ovary removed, but it is just a guess...a chance...a possibility.

The one thing I am sure of - the one thing that has not let me down yet - is trusting in my body and doing what I believe is right for me.

If I had followed the typical course of treatment/ recommendations:
1.  I would have had chemotherapy after my breast cancer surgery (on the off chance that a 3mm spot in one of three lymph nodes biopsied had shot cancer cells out into my body somewhere) in conjunction with the radiation therapy that I did have.

2.  Instead of just having both fallopian tubes and my left ovary removed,  I would have had a complete hysterectomy. The complete hysterectomy, per the Drs, would lessen my chances of ovarian and uterine cancers and would allow me to take the post-menopausal breast cancer drug without having to have shots to put my body into menopause (because the pre-menopausal breast cancer drug - Tamoxifen- had too many side effects for my body which actually caused the need for the surgery to remove my left ovary and fallopian tubes in the first place --oh, and don't forget that I am unable to take hormone replacement therapy because I had estrogen receptor positive breast cancer)

I truly shudder to think where I could be and what condition I may be in,  if I had blindly taken the "typical routes" recommended to me.
I did my research and I trusted my body - I trusted how I felt and what I felt.
Because I made these choices, I still have a monthly period, I do not have a hormone replacement issues and most importantly, I still feel whole.
 

"THUD"....the sound of the other shoe that dropped

I was hoping there would be no other news flashes, changes or "shoe dropping", but it  happened. On June 5, 2013 I had my follow up pelvic ultrasound (aka my "date with the ultrasound wand" as I call it).
That ultrasound led to many doctor appointments over the next several weeks and then surgery.

Although the majority of the Tamoxifen "accessories" I had gained during my 8 months of taking that drug had resolved, the left ovary was not returning to normal and that complex cyst was still there. The right ovary was fine and other things looked more normal, but the left ovary was very concerning. My ob/gyn recommended that I have surgery to remove the left ovary, left fallopian tube and biopsy the uterine lining to make certain that cancer was not lurking.

Needless to say, I was scared! My ob/gyn was calmly explaining the procedure, what would happen, etc and all I could hear was Charlie Brown's teacher's voice. The word cancer was on repeat in my head like a bad musac track from an elevator.
I went home and started a pity party for myself that lasted several days and included lots of crying, fear, anxiety and questions: "why me?", "what did I do to deserve this?" and "whose going to want me with no girl parts left and all the side effects that brings?".

We set the surgery date for June 28, 2013 and I prepared myself for the worst, but was praying and hoping for the best. I would have laparoscopic surgery under general anesthesia. The left ovary and left f tube would be removed, the uterine lining would be biopsied and all of that would have quick pathology done. IF any of those came back with cancer, then I'd have a complete hysterectomy (all my "girl parts" would be taken away). I agreed that I didn't want two surgeries so I signed paperwork that clearly stated to go ahead and do a total hysterectomy if there was cancer found.
Why wake up, hear the cancer word and then have to set another surgery date? No way. I decided to make it a "surprise" - which means I would not know if I had any "girl parts" left or another cancer diagnosis until I woke up in the recovery room.

Now this plan was finalized as far as I was concerned, but I was mistaken. There was one more decision I would have to make. I met with the gyn onc to review and discuss what would happen if cancer was found during my laparoscopic procedure. The gyn onc would be the one to step in and take the the procedure from three holes in my stomach to cutting me open and taking out everything and doing the staging (aka biopsying other bits and pieces in the surrounding areas to make sure cancer was not lurking somewhere else).
I was now hit with the new decision: if cancer was not found, why not go ahead and take out both ovaries and f tubes since I was already there under anesthesia and all?

This is where I began to fall apart - again. I had pulled myself back together (well, as much as I could) after agreeing to surgery and the original two options. Now, I had yet another decision to make: if there is no cancer found and hysterectomy is not needed, do I still give them both ovaries and fallopian tubes? In other words, do I say "yes" to surgical menopause without a cancer diagnosis?

The gyn onc explained, as my breast onc had previously explained, that not having ovaries could reduce my chances of a recurrence of breast cancer (I had estrogen receptor positive breast cancer). I'm not crazy, I had already said take out all the "girls parts" right then and there if cancer was found during the surgery.....but did I want to agree to give them parts that didn't have to come out?
It was being presented as a good news option......Hey, if you let us take both ovaries then you can start taking the post-menopausal breast cancer drug without having to take the shots to put your body into menopause....
I failed to see the "good news" aspect of this presentation. I had a lot of thinking to do and a huge decision to make in a matter of days.

I said NO to the extra donation to medical waste. I was determined to keep the right ovary and right f tube if there was no cancer! My gyn supported my decision (she is an amazing person and care provider by the way!). This way, I could consider taking the shots to throw myself into menopause and take the post-menopausal breast cancer drug. If the side effects from this drug were horrendous, I could stop the the shots and kind of come out of the menopausal state.  If I gave them both ovaries, there would be no turning back from a menopausal state. My age also played a part in this discussion - there was a chance that even if I stopped the shots, I wouldn't bounce back.

So here's what happened on my surgery date, June 28, 2013:
I woke up with some girl parts left, but not as many as I had hoped. My left ovary and f tube were removed as planned, but the right f tube looked suspicious so it was taken out too. I was able to keep my right ovary and uterus. Good news - no cancer found!

In case you need a quick biology reminder, no I cannot ever get pregnant now. Even though I knew that getting pregnant and having a child was probably not in my future, it was still possible - biologically possible, it could happen. Now, it cannot happen. This news was tough to digest. It was more difficult and upsetting than I had imaged. It is very difficult to go from "it probably want happen for me" to "it cannot and will not happen".

I am still recovering from the laparoscopic surgery (takes 4-6 weeks to regain 75% of your strength). The recovery has been more challenging than I expected. I grossly under estimated the healing and recovery time. I was comparing it to my breast cancer surgery - not a fair comparison by any means. I'm working back up to my 2 mile walks, morning yoga and ab workouts and I will get there.

Yeah, I'll get there.....I'll get there with my new normal, with decisions about future breast cancer drugs and moving forward with my life. Not having another cancer diagnosis is a major relief, but I still have to somehow wrap my head around what has happened to my body and come to terms with that.

Two years ago this month, I was happy that I had completed breast cancer surgery and my radiation treatments before my birthday. That was my goal two years ago - to have it all "finished" before my 2011 birthday.
Never thought I'd be here again. Never thought I'd be facing another "get well" goal before another birthday, but here I am.