BC Becky

Never thought I'd want to be a breast cancer survivor

Category: Spine

  • Five more years … and a back update

    Five more years … and a back update

    It has been a whirlwind over the last two weeks – with an appointment with my oncologist and an appointment with my back surgeon.

    I was pretty bummed out after my appointment with my oncologist. He again said that I was moderate to high risk for recurrence and that he wants me on some form of hormone therapy for another 5 years. We talked about options, since I really didn’t go through all the options when I stopped a couple years ago. When I stopped I was in pretty poor health. I had just been diagnosed with celiac and high blood pressure and was suffering from lymphedema in my left arm. There was just so much going on that I had to remove variables in order to figure things out, and the first variable was hormone therapy.

    In our prior visit my oncologist floated the idea of 5mg of tamoxifen. I think it is something they are testing for cases of DCIS and previvors (BRCA without a breast cancer diagnosis). Anyways, I agreed to give that a try. And so, for the last four days I’ve been taking 5mg of tamoxifen at dinner time. It causes a slight headache (or at least it did the first couple of days, last night went better). Fortunately, I’m usually pretty mentally burned out by dinner time, so it doesn’t have a hugely negative affect on my productivity. So far, it is something I can live with, so I’ll try that for the foreseeable future.

    I also had an appointment with my back surgeon. He confirmed that we would not do a fusion. He also explained that it would be a “partial laminectomy”. His goal is to remove the least amount of bone possible in order to still reach the nerves. Unfortunately, one of my disk herniations is on the side, which means he will need to move the muscle on the one side to get access. That is likely the part to cause the most pain, as it like spraining your back (ouch). I’ll have a 4 inch incision, but most of that will be superficial, as they will make a tiny hole in the area under L5 in order to access the nerve there and he will shave the disk herniation that is causing the pain. The other herniation at L4-L5 is lateral, so it means he needs to move the muscle to access it. As I understand it, it is about a 1-2 inch area.

    In the end, I feel a lot better about the surgery. He is being as minimally invasive as possible. He is also doing the minimum that needs to be done to clear the nerve pain. I am hopefully that after this I can get back to hiking. It has been a year since I’ve been able to go on a decent hike and I miss it more than you can image.

    What I wasn’t encouraged about is some of the degenerative changes in my back. These changes mean that at some point in the future, I’ll likely need a fuse – but he commented that if I’m careful to avoid lifting anything over 10 lbs and avoid too much strain in bending or twisting, it could be 25 years before the fusion is needed.

    I can hope to live long enough for that to happen. He commented on maybe needing it when I’m 75. This might sound rather morbid, but I just cannot think about being alive for that long. With both my parents dying in their mid to late 60s, and my history of breast cancer, I think it would be a miracle if I can make it to 75! That being said, getting back to hiking and regular exercise will go a long way to helping make that happen. It certainly won’t happen if I become immobile.

    Come January I ask for your prayers and healing thoughts as I do this surgery. I am not allowed to break a sweat for 6 weeks, as the surgeon wants to ensure the incision is fully healed before I do anything cardio related. I am also limited to walking about a 1/2 mile. I’m glad I asked the question, because all the paperwork says that walking is good, but that is written for people who generally don’t walk much. Had I not asked I likely would have been trying to walk 1, 2, or even 3 miles which would not give my body enough time to heal.

    And with that update, I need to get back to work … and back to focusing on dissertation writing and end of term marking.

    Happy Thanksgiving everyone.

    Feature image was taken at Cape Disappointment State Park in Washington.

  • Is this normal? Spinal laminectomy

    Is this normal? Spinal laminectomy

    Is it normal to have surgery booked after a short phone call with a surgical fellow outlining what surgery is being offered? Is it crazy to think that I might want an in-person appointment where the doctors show me my scans and explain exactly what the procedures they are suggesting entail? I’m finding it a bit crazy that I need ask for this appointment.

    The same thing happened with my mastectomy and reconstruction – I ended up booking an extra appointment so that my surgeon could go over what my scars would look like. I wanted to know what to expect so that I could prepare for it. I didn’t want to wake up and be shocked by it.

    I now have a date for back surgery – January 2nd. Luckly, the surgery will not be a fusion of my spine. I had a call with the surgical fellow who said something about a double laminectomy – Spine-Health has a great video that explains what a laminectomy of the lumbar spine is. In addition to the laminectomy, they are proposing a discectomy for the herniated disc. The spine-health video shows the minimally invasive discectomy, however, I don’t think that is what is planned, as they will already be in the area for the laminectomy, so if I understand it correctly, they would have access to the disk already and wouldn’t need to open a new incision. I think the lumbar laminectomy video by Blausen is closer to what would happen in my case.

    It just seems odd to me that a surgery this serious would not involve more detailed consultation. I wonder if it is just that people put blind faith in their doctors and are not so concerned? I just don’t get it. I want more information. That being said, I also want the surgery date that they have given me. The window for healing is ideal as it is in the window where I’m not teaching, so I can focus on healing and writing my dissertation.

    And so now I’m waiting to hear back – and find out when I’ll have that appointment where we run through the details of the surgery, and I can see my scans and picture it within my specific context. I’m guessing that I just misunderstood and that the nurse just forgot to tell me that there would be a follow up appointment. Either way, I’m not going into surgery without one.

    Did you have a detailed consultation before surgery? Did you need to ask for additional appointments with your surgeons or their support staff (fellow, physician assistant, or nurse)?

    Feature image by BruceBlaus [CC BY-SA 4.0] via Wikimedia Commons.

  • laminectomy or fusion … the woes of my spine

    laminectomy or fusion … the woes of my spine

    As some of you know, I’ve been struggling with back pain – which got severe after I broke my rib mountain biking at Christmas last year. I’ve tried a lot of different things to help improve it – PT, Yoga, acupuncture, massage, spinal injections, and decompression therapy – unfortunately none of it worked. Some of the methods did allow for some temporary relief – mostly taking the edge off that pain – but none of them have given me the sustainable relief that I am seeking.

    If you follow my instagram account you will notice that 2019 has a significant lack of hiking selfies – that is because I have not been able to hike. The pain with walking even 1/2 mile is crazy – I often need to swat down and stretch out my lower back to allow me to go on. I pushed myself to hike 2 miles the other day, and spent the rest of the day in bed with ice on my back. More than anything, I just want to get back to hiking.

    This back pain has also taken me away from the pool. I love to swim. At my “peak” I was swimming a mile (not very fast, it would take me 45 minutes). I miss the meditation that happens then I’m swimming and all I’m focused on is moving my arms and propelling myself through the water. Now when I get in the water and try to swim it is painful. My back hurts. It doesn’t like to flex the way it needs to based on how my body floats. Hopefully pilates will help balance some of the muscles in my stomach and back and make it possible to swim again.

    This pain has also taken a toll on my ability to cook. It hurts to stand for more than 10 minutes – and not just an annoying hurt, but it can get so bad that I need to lay down in order to relieve some of the pain.

    What’s the cause of the pain? I have a couple of herniated discs – one more significantly than the other. All in the lower spine – L5-S1 and L4-L5.

    I’ve started pilates and even have a private instructor who does pilates for rehab. I’m working with her on strengthening in preparation for surgery.

    I got a first opinion from a local surgery who wanted immediately to fuse a couple of my vertebrae – but that seemed rather extreme to me and had me look to other non-surgical options. I’ve now seen a good surgery who comes highly recommended. He laid out three options, depending on the results of scans that we don’t have yet: (1) laminectomy plus discectomy of L5-S1, (2) number one plus the same with L4-L5, and (3) some kind of spinal fusion. He didn’t really go into any detail because we need the scan results. Once the results come in, he will look at them all and make a recommendation.

    And so, this surgery is weighing heavy on me. The timing will hopefully be either late December or early January. This aligns with the 5-year mark from my last major surgery (my bilateral mastectomy with flap reconstruction). I’m afraid of all the memories that will be brought up during this time.

    Part of the desire for this timeframe is that I don’t teach in January, so it will give me some recovery time – however, that is also time that I hope to be working on my dissertation – which I will get back to right after writing this blog post.

    It will also be a different hospital – a little further from home (up at UCSF). The ability to choose a surgeon is a privilege that I am taking advantage of. I’m going to the best because I can – but this means figuring out the ins and outs of another health system – one that doesn’t connect as easily as the other two that I use more frequently.

    I remind myself that I got though a much worse surgery. I am cautiously optimistic that after the surgery, and the associated recovery, that I will be able to hike again. I want to be able to walk the various trails again. I see myself repeating my recovery process – with baby steps, short walks that gradually build back up.

    I will measure the success of surgery in my activities. It will be successful if I can hike, swim, and cook without pain. It will be one step at a time.

    Feature image by Joyce McCown on Unsplash

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