BC Becky

Never Thought I'd Want to be a Breast Cancer Survivor

Category: Surgery

  • October – it’s just another month

    Last year, I found myself reflecting on all the pinkness of October. I recall thinking that October will always mean something different for me. I blogged about how I wanted to kill all the tacky fundraisers and really talk about what it means to experience breast cancer – it isn’t about pink ribbons.

    This year, my Pinktober experience has been different. I haven’t seen so many outwardly offensive advertising campaigns. No pink drill bits. No show your boobies for breast cancer advertisements – which is by the one, of the most offensive things one can do for breast cancer survivors, many of whom are suffering from severe issues with body image.

    This year, my Pintober actually began in September. First with my presentation at the Queens University of Belfast ePatient blogging and microblogging conference (#qubept). There, I gave a presentation on the impact breast cancer blogs have on those who read them. In that presentation, I weaved in my personal story with the data I got from the survey. I really enjoyed writing in that mixed paradigm – as both a cancer survivor and as an academic. You can read my presentation here or see the recording here.

    A couple of days after returning from Northern Ireland, one of the support groups that I’m a part of launched their new book “Shivering in a Paper Gown: Breast Cancer and its Aftermath: An Anthology”. One of the stories in the book (page 20) is based off of a couple of blog posts I wrote, titled “Breast that are not Breasts“. I read the story to a very packed room at the book launch.

    With that, Pinktober began and for the most part I ignored it. A friend asked me to write a blog post about what advice I would give for anyone going through cancer now – along the lines of a lesson I learned that I wish I knew before treatment. She wrote a lovely post that integrated the thoughts from six women – although I’d personally change the title to add the work survivors at the end, as the lessons are not from “breast cancer” but rather from breast cancer survivors: Six Lessons Learned From Breast Cancer. It felt more like what I was seeing this year in Pinktober – more useful resources and less tacky marketing.

    Another friend lunched an important project for research on metastatic breast cancer. If you have mets, I highly recommend you take a look at the Metastatic Breast Cancer project (https://www.mbcproject.org/). There is also a Facebook group for those who wish to follow using that media.

    The other aspect of October that I am much more aware of this year is BRA day (yesterday). More specifically Breast Cancer Reconstruction Awareness Day. The shorthand BRAday makes me think of all things tacky about breast cancer; however, I think the movement itself is an important one. I had someone reach out to me about I post I wrote last year where I struggled with the vanity of breast reconstruction. Early in my breast cancer treatment I was completely incensed about how I was informed about breast reconstruction. Perhaps it was because it was a male surgeon who said it? Perhaps it was because he just got finished telling me I had cancer, and needed a double-mastectomy, but the “good news” was the insurance had to pay for reconstruction. It wasn’t the message I was ready to hear – but for many women it is a message that needs to be heard, because they are not getting it. They don’t know that the option is available to them.

    For me, my breast reconstruction decision is every present when I swim (which is frequently). Every time I put on my bathing suit and walk out to the pool, I’m highly aware of how my reconstruction decision means that I don’t need to worry about prosthetics or how I look in the pool.

    I’ve joined a swanky gym (something I can only afford because of the deal I get from the wonderful folks at Sunflower Wellness). It is more of a country club then a gym. They do, however, have good cardio machines and a great adult swimming pool. Actually, they have two 25 meter pools, the one that is adult only is a couple degrees cooler and almost always available for lane swimming – plus it is a clean salt-water pool – truly wonderful! After my swim yesterday, I notice there were a lot of people tanning or just hanging out in the lounge chairs around the pool. I felt like all eyes were on me as I walked to the change room. Feeling like I didn’t ‘belong’ in this swanky club. But, the pool is great and open all winter (my condo pool closes at the end of the month). I’m going to continue going to the gym, but will probably try to get there a little earlier in the day when the pool is area is less crowded (the pool itself wasn’t that busy).

    The women’s locker room is a bit of a challenge for me. Many of the women walk around naked. I am very self-aware about my scars. I opt to be as discrete as possible when I’m changing into my swim suit or getting dressed after my shower. I don’t think that I would have had the inner strength to manage this had I not had reconstruction. Now I find myself wondering if the women in the club think that I did it strictly for vanity reasons?

    I also find myself contemplating nipple tattoos. A few months ago I bought some rub-on tattoos but haven’t had the courage to try them. Now I find myself wondering if putting them on would give me more confidence at the gym? My friend Stacey talks about how the rub-on tattoos help with inner confidence. In some ways, it is part of the healing process, and part of the reclaiming process. We are reclaiming our female bodies after cancer has taken parts away. I may seem vane or trivial, but it is not. It is a small thing that we CAN do. As a ‘young’ person being thrust into menopause, having all the estrogen in my body blocked in order to prevent breast cancer recurrence, I cling to the aspects of femininity that I can control. I try to fight the side effects by exercising, and strengthening. I need the self confidence that allows me to workout at the gym, and swim in the pool, and change in the women’s locker room.

    So this year, October is just a month, like any other month. It is one where I am working on both inner strength and outer strength. I am working on healing.

     

  • Lymphedema

    At some point, I hope that when I am blogging here, I’m not having to tell you about yet another new side effect of breast cancer treatment. It seems, however, that as time goes by, if it isn’t one thing, it is another.

    Last Friday I mentioned some swelling in my hand. I knew the signs. The swelling wasn’t just in my hand, it was also in other parts of my arm. Since I only had sentinel nodes removed, and I didn’t have radiation, I was at low risk for developing lymphedema. Immediately upon detecting the swelling I reached out to my surgeon and my physical therapist (PT) as I knew that she was also trained in lymphedema therapy.

    I got in to see the surgeon’s NP last Friday. She referred me to the lymphedema specialists for an ASAP appointment. It has been a week, and I still don’t have an appointment. I have no idea when I’ll actually get in to see the specialist. This was causing me to go insane. I was scared. I found myself worried that what is stage 0/1 now would progress to stage 2 or more before I finally got in to see someone.

    Fortunately, I was able to get in to see my PT today.  She was able to calm my nerves. She was also able to tell me what I should and should not do, and she prescribed a compression sleeve. She taught me how to self massage (order of massage is important – turns out I was doing it all wrong).

    I’m not feeling a whole lot better in that my arm is still swollen and aches. We didn’t get a chance for any of the physical therapy – mostly the appointment was spent measuring my arms and talking about what I can to do help recover from this flare up. But I am relieved. I now know what I should be doing. I know that swimming is good, and that I don’t need a sleeve to swim. I better understand how to spot the signs of a flare up, and what to do when things do flare up.

    What this also now means is that I’ll have to wear a compression sleeve when flying. Certain types of larger aircraft are less likely to be a problem (they have higher cabin pressure) but most of the smaller and older aircraft will risk a flare up if I don’t wear a sleeve. When my arm first flared last week, I immediately thought that if I have to wear a sleeve I am most definitely going to get a pretty one. More specifically, one that looks more like a series of pretty arm tattoos rather than something that tries to hide itself but doesn’t.

    So I’ve ordered myself a pretty compression sleeve from Lymphedivas. It won’t arrive until sometime next week. My PT ensures me that I don’t need anything urgently – that adding self massage to what I’m already doing will be adequate treatment until I get my sleeve. Once I get the sleeve, I’ll need to wear it during the day until the swelling goes down. Then I’ll need to experiment with exercise – wearing the sleeve at first, and then trying light exercise without it. My oncologist also mentioned that I will probably want to wear the sleeve when I bike. I can see how, that some of my shoulder pain might have been an early sign of lymphedema. I now have a much better understanding of what I can do to manage it.

    I still have no clue when I’ll get in to see the specialist. I may have it all under control before then!

  • A picture is worth 1000 words

    A picture is worth 1000 words … or so they say.

    I recently participated in an interview for an academic study on care and vulnerability among academics. When asked about where I draw the line with what I share, two things came to mind. First was in areas around sexuality, and second was with pictures of my breasts. I’ve struggled with both, in part because I think there are things that need to be said, and would be valuable for others going through breast cancer to hear – but there are still limits to what even I am willing to share publicly on the internet.

    That being said, a friend is about to go through the same kind of reconstruction surgery that I went through. When we talked about it, I was able to show her some photos that were on my phone. These were a great help to her. She was comforted by my success stories, as most of what she had seen were the horror stories.

    When I was at the ed tech conference in Texas a couple weeks ago, there were a few people that I showed pictures to. Again, this was in part to help them better understand what was involved. It was a sharing that helped to deepen our relationship.

    I have struggled with how I could share pictures in a way that was not so public as this site, but would allow me to still share them with people who want to see them. I thought about putting them into an ebook behind a paywall – so only those who paid for them would see them, but that didn’t really seem to address my concern. Part of it is, I want to know who has seen them. Even if the person is a complete stranger, I still want to know who they are. It is because the sharing of such pictures is sharing an intimacy (note that the pictures do not involve face or groin (except one or two) – that is intentional. They show the scars and the wounds in a more objective manner. They help the viewer better appreciate what the surgeries entailed. They help the viewers better prepare (or empathize). But they also serve to deepen the relationship between me and the person viewing the images.

    With that said, if you are reading my blog for whatever reason, and you do want to see the pictures of my wounds (photos taken almost daily from my first surgery through to mostly healing of my scars), then please email me (rhogue@pobox.com). I will not post a link here. I will not post the password here. I will, however, share with those who read this blog and want to know me on a deeper level – or who want to better understand the outcomes of the surgery that I had. Just send me a note to let me know a little something about you, so that I know I’m not sharing my photos with someone who will publicly display them or exploit them in any way. Because, sometimes a picture (or in this case a series of pictures) is worth more than 1000 words.

  • Learned something about my new breasts today …

    I had my post surgery follow up with my plastic surgeon today. All is healing well. Next follow up in three months or so just to check that things are healing well. She did say that I needed to take it easy for the first three weeks after surgery (so another week and a half), and that I should slowly add each sport and see how it goes. She so doesn’t know me … anyways, it will be a challenge, but I shall do my best to take it easy for another week (no biking, no gym, no swimming) – I think I can achieve the latter two, but biking might end up back on the table sometime mid next week. I did get full clearance to return to my range-of-motion exercises (which is more like yoga and gentle exercise).

    I had been told a while back that I should not be looking for “lumps” in my new breasts. That I no longer have breast tissue, so I need not worry about lumps. So, I asked my plastic surgeon about the hard spots at the bottom of my breasts (both can be quite firm). She pointed out that I no longer have lymph nodes in my breasts (my pathology reported that two nodes were removed from each breast as part of the mastectomy – all nodes were clear of cancer). The flap tissue does not have lymph nodes. The tissue left after the mastectomy can swell and fluid can pool because there are no lymph nodes to encourage drainage. If I spend most of my day upright (and I do), then the bottom of my breasts can feel hard (this is especially the case when I lay down). To help soften them I can do some massage to encourage lymph drainage – massaging towards the center chest wall. If the skin, when pinched, looks like an orange peel, that is mastectomy skin and the firmness can be quickly massaged away.  Once I tried it, I saw was surprised that it only took like a minute or two to make things much softer. Why, oh why, did someone not tell me this sooner?

  • Shopping for some shapewear

    I’m healing. I’m also starting to think of the surgery last Tuesday as my last surgery – the last surgery as part of my active treatment for breast cancer. Arguably, this surgery wasn’t part of my breast cancer treatment, rather it was follow up ‘revision’. It was mostly cosmetic, except for the hole in my stomach, which I’m happy to report is no longer a hole.

    I bought some new “shape wear” to wear underneath my clothing. These items mean I don’t need to wear the bulky post-surgery abdominal brace that I wore for 8-weeks after my reconstruction surgery. One of the challenges with shape wear was figuring out exactly what I wanted, and how it would work for me. Fortunately, a trip to Macy’s resulted in a few different options. Here are two that are currently working for me:

    • Jockey Microfiber Slipshort – In order to get these to provide enough support for my inner thighs (which are sporting nice post-lipo bruises) I had to go with the size small. I’m a little dumbfounded that I even fit into a small!
    • Jockey Tank Slimmers – I bought this one in a large and a medium. I’m currently wearing the large, but feel that once some of the swelling has gone down and I’ve lost the post-surgery water weight, the medium will fit better. This is what replaces the abdominal binder – as it provides compression around my entire abdominal area (from under breasts to hip bones).

    I am also wearing a sports bra that provides compression to the sides of my breasts (the other area that was lipoed) but also holds the bandages in place over my incisions (I can’t have any tape on my skin). After the shopping trip, I went into my closet and tried on some shape showing clothing. I’m quite happy with how I look! (never thought I’d actually wear that t-shirt).

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  • Tuesday’s Surgery

    It was definitely a day full of drama, but I’m glad it all worked out in the end. I was amazingly calm throughout the wait.

    It all really began on Monday morning when I called my surgeons office to let them know I had a fever on Saturday and Sunday nights. The fever cleared up on Sunday during the day, but came back with a vengeance on Sunday night (38.4 C), so I was concerned that I had an infection and or the flu, and that I might not be able to have surgery. My surgeon suggested postponing to Wednesday and ordered some antibiotics.

    Then I talked to her surgery scheduler who told me that I had a surgery spot, that is an OR booked with my name on it, for Tuesday (9am checkin for 11am surgery). If I delayed to Wednesday, I would be 10th on the OR wait list, so not likely to get in, but they did have a cancellation for next Tuesday so that was an option. I asked her to go talk to my surgeon and my nurse, and to keep the Tuesday spot. By this point in time it was Monday afternoon and I was feeling OK.

    I received a phone call from the Stanford surgery folks telling me when and where to show up. I thought all was good. I did not, however, hear back from the women’s cancer center folks (my surgeon or her nurse) and I didn’t think to call them before the office closed.

    Tuesday at 9am I showed up for surgery. As I was being checked in, my surgeon’s scheduler called me. I told her, I was there and being checked in. She paged my surgeon to let her know. My surgeon and her nurse wanted to check to see that I was feeling OK. By 10am, I confirmed with the scheduler that I was feeling OK, so my surgeon came over to the main hospital OR, where I was, and drew all over me (pre-op markings). Since it was crowded and there was a delay with my OR, they put me back outside in the waiting area. While there, my surgeons nurse calls to apologize for the mix up thinking that the surgery had been cancelled. I told her that I had already seen the surgeon and things were good. Then the OR prep nurse came out (I thought she was bringing me back to prep me) to tell me that main scheduling had cancelled because I had a fever – to which I said, no, the surgeon already cleared me and drew lines on me. So the OR prep nurse went back in to check, and then gave me the thumbs up that we were good to go.

    With all of that figured out, we sat out in the waiting room for another hour. At some point a clinical trial person came by to drop off the vials to collect my blood. Then we waited some more. It was after noon by the time I was brought back in to changed into a hospital gown.

    The medical assistant drew my blood for the clinical trial – from the one good vein in my hand. I’m sure I mentioned several times that a line should be put in, not just a blood draw. I’m a hard stick at the best of times, so I thought that the anesthesiologist was going to be the one drawing the blood. While my blood was being drawn I had an asthma attack. Half an hour later the anesthesiologist shows up. She is a little pissed at the medical assistant for drawing blood on the one good vein in my hand, especially because it was only a clinical trial draw and not a doctor ordered one. Fortunately, the anesthesiologist was a miracle worker and found another vein in my other arm – she got it on the first stick – both hubby and I were impressed.

    Ready to go, we got told the OR was not ready. The surgeon using it before my doc was taking longer than scheduled. Then it needed prepping. At 1:15 pm we were told it would be ready at 1:30pm, but then another glitch. The attending anesthesiologist (I think my anesthesiologist was a fellow) wanted a type and cross match in case blood was needed. Because I have antibodies in my blood, this would take over an hour even with a stat order. Not wanting to delay, they paged my surgeon to confirm that the blood testing was not going to be needed. So, with everything finally lining up, I was wheeled in at 1:30pm. I remember being wheeled into the OR and thinking it looked more like a supply closet than an OR. It was cold. I was stiff, so had difficulty getting onto the table. Once on, I remember the spinning of the room and giggling as the anesthesia took effect.

    Here are a few pictures of my belly wound:

    Looking at the picture below, I can see that on Saturday I did have some signs of infection. Unfortunately, I didn’t take a picture on Monday night or after my Tuesday morning shower.

    What really surprised me was how much more mobility I have after the surgery. I had not realized that the toothpaste tube sized scar tissue and holes were restricting my abdominal mobility. Now I need to be really careful not over stretch and risk tearing open the wound (it is glued shut). In addition to the belly wound clean-up, my surgeon also fixed some drain scar tissue that was bothering me, and cleaned up my breast scar tissue, and did a bunch of abdominal liposuction. I’m already really happy with the results, and things will be even better when they finish healing. On the ride home from the hospital, I was reflecting on how I felt better immediately after this surgery then I did going into my last surgery. This was so much easier than the cancer surgery – especially because my body was so much stronger going into it. Today, I’m feeling good but aware that I am spending too much time in front of the computer in a seated position … my body needs me to spend more time lying down – so off I go 🙂

  • It’s all in a name – Patient Safety #medx

    At the hospital yesterday, the nurse practitioner who saw me during my hospital stay back in December remembered that I am sometimes called Becky. When she called me Becky it felt so out of place. It didn’t fit. At the time, I could not articulate why.

    All the medical assistants and nurses in the pre-op area, and even the doctors that I don’t know, call me Ms. Hogue. Actually, Scott commented that he needs to remember when I’m in hospital to answer to Scott Hogue (hopefully he won’t need to remember that again anytime soon). Those that have been my doctors for any significant amount of time call me Rebecca (or Ms. Hogue). They don’t call me Becky. Even those that read my blog don’t call me Becky.

    I use the name Becky in informal settings – with close friends, at church, and on my breast cancer blog. It feels right in this setting. At school, it felt a little awkward when my PhD friends made the transition from Rebecca to Becky – in some cases friends have not made that transition. It isn’t a measure of closeness either – just that some call me Becky and others call be Rebecca.

    My preference for Rebecca in formal settings is all about my initials. You see, I’m not BJH, I’m RJH. It is rather unfortunate that the shortened form of my name does not use the same initials. People from other cultures don’t always get that Becky and Rebecca are the same name. In academia, initials matter, because when you publish your articles are published using your first and sometimes middle initial. I am RJ Hogue. I like the initials RJH – they represent me. Funny story though, my parents named me Rebecca Joanne so they could call me “BJ”, but then never really did. I’ve been Becky-Jo, and some family members still call me Jo or Jo-Jo, but I haven’t really ever been a BJ.

    On the car ride home from surgery last night I realized why it felt so wrong that a nurse would call me Becky – it is actually a patient safety issue. Nurses that don’t know me almost always call me Ms. Hogue. This isn’t just a formality, it is a way to ensure they are treating the correct patient! Every time they use my name, they are providing a check that they are giving the correct care to the correct person. When they read my wrist bands, they see Rebecca Hogue – they do not see Becky Hogue. The hospitals online records do not use my nick-name, they use my formal name. I’m sorry that I was not able to articulate my discomfort with being called Becky at the time, but now I understand where that comes from. Now I know that it is a safety issue, and that it is most appropriate that in a hospital setting I am Rebecca Hogue.

  • Patient care fail – when allergies hit

    First of all, for those out there following along, my surgery went well. I’m writing this now because I’m not ready to sleep yet and it is just slightly too soon for my next round of pain meds – which I want to take just before trying to sleep.

    For the most part, my patient experience today went well despite the delay. There was one pet peeve of mine that I think it deserves a blog post. Shortly after having changed into my hospital gown, while having blood drawn, I had an asthma attack. Through coughs, I directed the nurse to where my inhaler was (in my bag, since I only had on a hospital gown). She complemented me on remembering to bring along my rescue inhaler. She also tried to get my bed relocated because the loved-one for the person next to me was wearing perfume – which is most likely what triggered the asthma attack. Unfortunately, things were really busy, so there was no spare space. The nurse validated I was OK and they left me in the spot.

    Here comes my pet peeve and rant. At NO TIME did they ask the loved-one who was wearing perfume to leave – or move away. The asthma attack was treated as my problem, and not the problem of the person who caused it in the first place! In this day-and-age, why is it OK for someone to wear perfume in a hospital? And especially in the pre-operative area of a hospital? None of the patients are permitted to wear it – heck, you are required to shower twice with special soap and put no lotions or creams on your skin.

    Until places like hospitals adopt zero tolerance policies on things like perfume, the practice will continue. And people like me will be the ones to suffer – not those who are doing the offending in the first place.

    Please take note – <begin rant>  if you like to wear perfume – stay away from hospitals, concert halls, and expensive restaurants (where the food is meant to be smelled not the person next to you) <end rant>. And nurses, I don’t care how uncomfortable it makes you feel to ask the offending person to leave, you need to stop punishing the patient! Ask the offender to leave, perhaps ask them to use the restroom to wipe off as much of the perfume as possible … it may be a futile exercise, but it will send a message, and perhaps that person will think twice the next time.

  • Plastic surgery and post breast cancer vanity / guilt

    When I told one of my colleagues at the University of Ottawa that I was moving to Silicon Valley in California, she comment that she thought it was “Silicone valley, because of all the fake boobs”. At the time it was rather funny.

    Living in California especially, the whole idea of cosmetic plastic surgery is loaded. It brings to mind women who feel the need to change their looks in order to be accepted, or to get that acting job. It brings to mind millionaires who can afford to have their bodies sculpted as a way to try to increase their self confidence. It reeks of vanity for vanity sake, and feels judgmental.

    In the last couple of weeks others have posted about the frail body image of women who have gone through breast cancer treatment: Nancy talks about reclaiming body image, and Diane talks about coming to terms with your post-cancer body.

    I never would have thought of myself as the type of person who would have voluntarily opted for cosmetic surgery. So far, I’ve been able to self-justify my surgical decisions. My first plastic-only surgery is scheduled for tomorrow (or next Tuesday, I’m awaiting word). If I didn’t have a hole in my belly, it would be considered strictly cosmetic (scar tissue clean up and liposuction of the abdomen). It would not be medically necessary – and yet it would still be covered under insurance. One benefit to breast cancer is that while I’m insured in the US, I’ll have unlimited access to revision surgeries.  This means that if I decide 6 months from now that I want larger breasts, I can go in for a fat grafting procedure, where my plastic surgeon will do liposuction on a secondary site (e.g. my thighs). I can choose to have my body surgically sculpted.

    With this comes waves of guilt. I find myself self-justifying the procedure. I’m more interested in the lipo of the thighs than I am in want of larger breasts.

    Unlike many women who go through breast cancer treatment, I’ve always been able to look at myself in the mirror. When I look at my wounds and my scars, I am not judgmental of what I see. My lines are kind of funny at the moment, which is what I’m hoping the plastic surgery will fix – I feel guilty that I want my body lines to run smoothly without the extra pouches of fat.

    I’m more concerned when I look at the scale. I hate that chemo and now the anti-hormone treatments make it nearly impossible to loose weight. I do eat right. I do exercise. Nothing seems to work, so there is that ray of hope that comes with the thought of plastic surgery – but also that twinge of guilt at the thought that I’m letting my vanity get the best of me.

    I’m afraid to go clothes shopping – I’ve completely avoided it for the last 9-months – such that many of my clothes are threadbare and in desperate need of replacing. My body is a completely different shape now. The last surgery changed my hourglass shape into something more of an A-frame. It may change again with this next surgery, so I’m waiting to go shopping – I’m waiting for things to be a little more stable but I cannot wait indefinitely.

    My emotional self gives me permission to do any of the plastic surgeries that I want. I’ve earned the right to choose to have my body sculpted. My thinking self argues back that I’m being vain – that I might be opting for surgeries for vanity reasons only, and really they are not necessary. But then I ask myself, does reclaiming a positive body image worth the surgeries? Will the surgeries really help? Am I being weak by feeling that I might need the surgery in order to have a positive self body image?

     

  • An epic ride

    Today’s ride was rather significant for me. For the first time since treatment, I made the ride up Mount Hamilton from the Fire Station. The last time I did the ride was back on June 20 – just as I was starting this blog. Since then I’ve been through 16 weeks of chemotherapy and two surgeries. I am thankful for the time I’ve already spent with the Living Strong Living Well program, as it certainly has helped me gain some of my strength back. I was clearly not as strong climbing today as I was back on June 20th, but this time I also wasn’t stopping at every corner to cry (rather I stopped frequently to drink).

    After the first 30 minutes (and 2.8 km) I didn’t think I had any hope of making it to the top. But I stuck with it, and 2 hours later I made the last pedal strokes up to the Observatory (2.5 hours up, 35 minutes down).

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    What is also significant about this ride, is that I was doing it in part to celebrate being 3-months cancer free. Technically, the last bit of known cancer was removed from my body on December 17th, 2014 – which was confirmed with the pathology on December 29th. March 17th, the 3-month mark exactly – is Tuesday – also the day in which I have scheduled for my next (and hopefully last) surgery. So, I’m not going to be able to ride on Tuesday … and who knows how long it will take me to recover from this surgery, but this time I’m going into it strong!

     

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