Sometimes we take steps forward, sometimes we take steps back.  Usually, we have a net gain in forward progress, other times we remain stationary.  Cathy had her third drain removed yesterday at the plastic surgeon's office.  That's good news!  Drains are ok, but they are kind of an inconvenience.  Speaking of inconveniences, Cathy has a leaking expander.  Her right expander is doing its job, holding fluid and stretching the skin and muscle to prepare for a permanent implant.  In the last fortnight, the left expander has gradually lost volume until it was empty and slightly buckled, much like a deflated soccer ball.  It was originally filled with slightly more saline than the other side, so to see it so much smaller made its malfunction a certainty.  

Dr. Butterfield was ill with the flu and thankfully didn't attend her office hours yesterday, so we saw the physician's assistant, Kristin.  Kristin conferred with Dr. Butterfield by phone and they decided the best course of action was to fill the left expander to see how fast the fluid is exiting.  If it is a slow enough leak, the plan is to fill it every week or so instead of every other week, then make the swap for the permanent implant early in January instead of late in February.  If the leak is too fast for that it will likely need to be replaced sooner.  

It was explained to us that there is a kind of no-man's-land for follow up surgeries.  Cathy is currently in that no-man's-land at 15 days post-mastectomy.  If a second surgery is pursued within 7-10 days of the initial surgery, the tissue hasn't begun the healing process in earnest yet and can defend itself against infection and excess bleeding.  The same is true 5-6 weeks after the initial surgery.  In between week 2 and week 5 the tissue is healing and building new blood supplies, making it difficult to work with.  So, we're hoping that plan A works and we don't have to think about plan B and C.  We'll go back tomorrow for an evaluation and hope that we can continue down the path of frequent saline injections.

I am thankful for Cathy.
I am thankful for the healing God has done in her body these last months. 
I am thankful for four loving parents in various states of retirement who help us when we have have cancer, or torn ACLs, or new babies, or food poisoning, or other things. 
I am thankful that those same parents are a beautiful example of love for us and for our children. 
I am thankful for great friends and neighbors who are steadfast long beyond any reasonable amount of time. 
I am thankful for good food on Thanksgiving and many other days of the year. 
I am thankful for three amazing kids. 
I am thankful for job flexibility. 
I am thankful for God's grace, forgiveness, and presence. 
I am thankful for time with my family. 
I am thankful for the ability to find peace. 
I am thankful to live in a country where we have only known freedom and peace on our soil for 150 years. 
I am thankful to live in this neighborhood. 
I am thankful to have found true love. 

Cathy continues to amaze me.  It hasn't been a week since her surgery and she's weened herself off the Percocet.  I don't think she made this move because the pain had decreased at all.  Instead, I think she was tired of being in a fog all day from taking Percocet and Valium.  She's continuing on the Valium because some of the muscle spasms are still pretty intense.  Of her four drains, only one is producing a consistently large amount of fluid.  Another produces a medium amount and the other two yield barely enough to measure.  Hopefully, two of those will be removed today when we see Dr. Butterfield.

Yesterday we apparently missed an appointment with Dr. Manders that we didn't know we had.  There must have been some sort of mix up with the nurses and the discharge papers and who was going to call whom.  Dr. Manders called Cathy yesterday to find out how she was doing and give her the pathology results.  She said that the pathologists couldn't find any traces of cancer in the tissue that was sent out.  Dr. Manders referred to this state as a "complete pathological response."  Those are three pretty sweet words.

This entry is dated Wednesday, November 14.  Apparently it didn't post from my iPad while at the hospital.  The previous entry is one I just typed on Saturday, November 17.  Now I know why people don't feel informed.  My apologies!

From our window we see the day breaking on Price Hill, Union Terminal, Fairmount, and Bellevue Hill Park. It's beautifully sunny, but the rising vapors tell us that it is a very cold morning. Cathy and I spent the night in a room by ourselves. It didn't start that way. From recovery, Cathy was brought to a shared room. A shared room is not a big deal, however, Cathy's roommate was a smoker, as were her visitors. The smoke smell was pretty overwhelming. Cathy did not complain about the smell, but she was a little bothered by the extremely loud profanity and the incredible amount of uncovered coughing that was going on.

Now, I'm normally a "roll with it" kind of guy, but all of this was a little excessive and would have been detrimental to Cathy's recovery.  Cathy would have been proud of me if she were a little more coherent because I was very persistent and insistent that she be moved. It worked!

Cathy slept a little. Her pain is pretty high right now. Those of you who know Cathy know how the extent of her pain tolerance. She spent most of the night at an 8. Valium helped to relax her muscles and made her tired. Dr. Manders made a surprise visit this morning (she said that she would be covering Thursday and Dr. Butterfield today) and confirmed that Valium would be the best way to go for pain management. Cathy's morphine button doesn't help much, but Valium relaxes the muscle spasms that are causing her pain. We're both all for less narcotics, too. Cathy has accepted the offer of higher Valium doses at greater frequency and has put her morphine button to rest. Hopefully, she will be able to sleep a little more and get up and walk around later today.

Captain's Log - Stardate 1117.12

The Enterprise has passed through Sector 1 of the Galaxy Cancer and has encounter some turbulence in Sector 2.  In Sector 2, aliens briefly abducted her body and made some alterations to her physical and mental makeup.  Since her abduction she has been wearing a very tight fitting white bra that snaps and zips in the front.  It conceals two silver sponges made of antimicrobial material that cover the areas of alien experimentation.  All of that is covered in a clear adhesive material that is pressed tightly to the skin of her chest.  On either side of her chest they have inserted tow tubes, totally four tubes.  The tubes transport blood and lymphatic fluids from under the clear dressing and deposit them into four clear colored receptacles that resemble grenades.  The grenades are pinned to the bra and are collapsed so as to utilize the power of negative pressure to draw the fluids out of her body.  The aliens intend to assess the amount of fluids that are extracted from her body over the next several weeks.  The aliens also inserted two tubes into her back through which non-narcotic fluid flows directly into her spine.  There are two dials that allow Commander Cathy and the crew of the Enterprise to adjust the rate of flow of this non-narcotic fluid.

The aliens seem to feel some remorse regard the non-narcotic nature of the fluid flowing into her back.  Therefore, they have placed her on a regimen of Percocet and Valium that have assured that they may continuously control her mind.  Commander Cathy and I have had a collaborative relationship with regard to commanding the Starship Enterprise over the last 15 years.  The substances the aliens have placed in the Commander's body have made collaborative command of the ship difficult.  On many occasions our conversations regarding care of the crew and battle plans have been repeated, with Commander Cathy having no recollection of our previous conversations.  This has put a strain on the ship, but control is adjusting - I just have to remember that the Commander may or may not remember our plans.

While Sector 1 of the Galaxy Cancer left Commander Cathy with no hair on her scalp, only a few dozen eyebrow hairs, and eyelashes numbering in the single digits, Sector 2 has brought on the growth of many short, soft hairs on her scalp and three tiny new eyebrow hairs.  The alien experiments in Sector 2 may have left her in a reasonable amount of pain, with some physical discomforts, and with a very cloudy mind.  However, we are grateful for the benefits that have come from our exit of Sector 1.  I am pleased to report that all of the side effects of the alien experiments on Commander Cathy are of the sort that are to be expected.  The side effects are not fun, but none of them are out of the ordinary.

Commander Cathy, the crew of the Enterprise, and I are looking forward to passing through Sector 2.  Sector 3 promises to bring much more optimism, especially since the other side of Sector 3 is the outer boundary of the Galaxy Cancer.  After leaving Galaxy Cancer the entire crew is anticipating the exploration of Galaxy New Life.

Cathy made it through a very successful surgery!  We were expecting a four hour surgery, but after just a little over an hour my pager vibrated. Christ Hospital surgery pages waiting families much the same way a hostess at a restaurant would call waiting patrons to their tables.  They even use the same kind of dual purpose pager-coaster. If it wasn't so early in the morning I might have wished I had a pint to set on my pager-coaster.

Dr. Manders told me that Cathy's surgery went very well and that her tissue looked very good - no visible signs of cancer elsewhere. Much like the biopsy, the pathology report on the removed tissue will tell the full story. Dr. Manders said that Dr. Butterfield had already begun her work and that they had worked side by side for a while.

After leaving the consult room I made some phone calls and texts. I returned to the waiting area and after reading only a few paragraphs of a book the pager rang again. Dr. Butterfield finished in just over two hours total surgery time. Dr. Butterfield expressed cautious optimism. She said that Cathy's tissue was in great shape, but with neoadjuvant chemotherapy she never feels completely at ease until after three or four weeks. At that time she will know how well the tissue has healed. Up to that point it is difficult to tell how that tissue will respond in terms of circulation and infection defense.

Cathy is in a room with a nice view of the winding Ohio river and some trees clinging to their fall colors. She has some pain in her chest, but is doing well otherwise. Her pain is at its greatest when she takes a deep breath.  She is speaking coherently, although quietly.  Thank you all for your prayers and well wishes!

I'm back in the Christ Hospital surgery waiting room, blogging from the iPad and hoping I don't have too many iPad related typos. Cathy just went back for surgery.  We had about two hours of prep before they rolled her down the hall to the OR.  She dressed in typical gown wear with some very fashionable tights to prevent embolism.  An IV was started with saline.  They checked her potassium since it was low prior to her biopsy.  We were very happy that it had gone up to 3.5 from 3.2.  Dr. Manders and the anesthesiologist feel comfortable with anything over 3.0, though.  The nurse gave her a sedative, then the anesthesiologist came in to insert the transvertebral pain pumps.  These devices consist of two regulators that are attached to a medicine supply. The regulators deliver the medicine directly to her spinal cord through two catheters placed about an inch and a half on either side of her spine. It works in a similar fashion as an epidural, but since it is between her shoulder blades she will be able to walk and will manage the pain in a very localized area.  We expect about two hours of mastectomy and two hours of reconstruction.  Cathy has been very brave, calm, confident, and predictably chatty throughout all of this.  She is a marvel.

The last couple of days have been full of good news!  Throughout these months I've been telling myself not to get too high or too low, just even keeled.  Although the Goodness of these days has been Great, it is tempered by the knowledge that in one week things are going to get much more difficult.  Even keeled.

My last post was pretty short, but got the point across.  Even though I was really tired at the time of that post, I thought it was important to communicate that information!  We had an followup appointment with Dr. Manders today that confirmed, indeed, that all of Cathy's lymph nodes were negative for cancer.  Dr. Manders thought she took out 6 lymph nodes, but it turned out that one of the nodes was actually four little tiny nodes clumped together.  That means that 9 lymph nodes were clear!  No cancer in the lymph nodes means no radiation.  No radiation means reconstruction at the time of mastectomy.  Reconstruction at the time of mastectomy means a shorter road to recovery.

All this talk of mastectomy and reconstruction points to the appointment we had with Dr. Butterfield, the plastic surgeon, yesterday.  Dr. Butterfield has apparently been told of the node pathology because she greeted us with, "So, good news!"  We talked through the reconstruction and learned a little more about the drains, the expanders, the recovery time, and other details.  We were excited that we could talk about Plan A, because there was to be no radiation.  Dr. Butterfield told us that Dr. Manders would take about two hours, then she would come in for another hour and a half to two hours.  We were thankful that there wouldn't be a longer time of anesthesia.

On the way home we talked about our conversation with Dr. Butterfield.  The surgery time seemed short to both of us when considering all the work she had to do with the latissimus flaps and the reconstruction.  Dr. Butterfield had also talked about expanders and I told Cathy that I didn't remember expanders being necessary in an LD flap reconstruction.  We were both beginning to feel a little confused.  I asked Cathy to call today to make sure that LD flaps were still the plan - so we're all on the same page.

Cathy called and Dr. Butterfield told her that LD flaps were her radiation plan!  She thought LD flaps would be important for a good result to compensate for the damage that radiation would cause the tissue.  Given Cathy's healthy body and having plenty of skin, she said that expander and implant reconstruction would be much preferable to LD flap reconstruction.  Thus, the shorter surgery time AND Cathy is super excited about not having two surgery sites to heal!

Lots of good news, but still a hard road ahead.  Cathy is tough.  Good news item #3 - peach fuzz.

Sooooo......lymph nodes are clear.

Cathy is pretty sore, but she's doing well.  She's worked her way off the percocet and is just taking tylenol now.  She has a little numb place on her back just behind her armpit. She read that sometimes nerves can get damaged in a sentinel node biopsy.  We aren't too worried about it, though because everything is going to get rearranged in about a week anyway.  

On an amusing note, every time I've gone to the bathroom the last few days I've felt like I was on an airplane.  Dr. Manders said that the blue dye might cause Cathy's urine to be "a little bluish-green."  However, it's been a hilarious shade of bright blue that looks just like an airplane toilet.  It gives me that "I'm going somewhere on vacation" feeling.

Cathy made it through round 1 of surgery very well today!  She is upstairs resting now, having just mild pain.  That pain should probably ramp up pretty significantly tomorrow, though.  Dr. Manders made just a small incision under her armpit, but said that she went in deeply through that incision and pretty close to the chest wall.  The blue dye and the radioactive dye both tracked well through her lymph system and Dr. Manders was able to identify 6 lymph nodes for extraction.  She called the lymph nodes "tiny," which is a good indication, as heavily infected lymph nodes are generally larger.  She did caution, however, that there is still a possibility of isolated cancer cells within those lymph nodes.  We will know the outcome of the pathology on those lymph nodes on Monday, probably.  In the meantime, Cathy is going to rest and heal.

We arrived at Christ Hospital this morning at about 6:30. Cathy has been her usually calm and brave self, although I can tell there is a little underlying apprehension. This is different than when she had her appendectomy. There wasn't time to think about that surgery. She's been think about today's surgery and the upcoming mastectomy on the 13th for months now. She didn't sleep well last night. I, on the other hand, had a great night's sleep thanks to my mom caring for Clara. I know she's concerned and those thoughts are weighing on her. As for me, exhaustion is an amazing sleep tonic. 

The little scalpel on the tv screen tells me that Cathy is "open".  The screen is almost like a status board at the airport, giving name coded information about each patient. Cathy is EW..G, C. The screen indicates that she entered preop at 6:43 and the or at 8:07. The scalpel just popped up. The anesthesiologist thought that we would be home by noon as long as she responds well to anesthesia. I'll make another post when we return home.