Treatment Notes:

– some warmth during the up-from-under portion of today’s program, otherwise not much, kinda in-zap-out

– I laid myself down on the table this morning Without taking my dress down – they had to remind me (and they were so good about it too)!  Oops!

Doctor’s Visit:

– there’s a first time for everything – I’ve never been treated like an addict before.  I finally realized that is the POV that Dr. Sanghani is coming from.  (Yep, naming names.)  I told her that I haven’t had a pain-free day in 14 weeks (since my first surgery).  My intention was to convey the fact that when one’s been in pain that continuously, one’s pain-tolerance may drop.  My dad had a different interpretation – one which never occurred to me: that I’ve been on pain meds every day for the last 14 weeks.  Which I have actually.

What she did not seem to hear and/or take into account is that what pain meds I’ve been taking have changed with my needs over that time.  The highest I was taking was Norco 10 (10 mg hydrocodone/325 mg acetaminophen) right after my 2nd surgery – for about a week or so.  Then something miraculous happened…I stopped taking it because I didn’t need that much pain relief anymore!  :-O  Oh my gosh, I have the ability to self-regulate my intake of pain meds according to actual need – just like a real non-addicted adult!  Can you imagine such a thing?  As it happens, when I first started radiation, I was down to two Aleves twice a day and that was doing the deal.

But let’s be real – the object of my radiation treatment is to destroy cells.  Sorry, well actually I’m not sorry if that makes some people uncomfortable, using those words.  I’ve left my sugar-coating this stuff behind a while ago.  The object of the treatment is to cause damage (a measured amount, more or less, to be sure, but still damage) in my body.  Causing damage to the human body nearly always results in pain.  This treatment causes skin damage – irritated skin can be painful.  This treatment causes swelling in the radiated area.  Swollen tissue presses on nerves – often causing pain.

It is not nearly in the neighborhood of crazy that I should be experiencing pain (increasing pain, as more deliberate and intended damage is done to my body over the course of the treatments), and desire some relief from that pain.  Also, I have recent experience with some pain relievers, and you know that disclaimer they put on narcotic Rx’s: “May cause drowsiness – Take care while driving or operating machinery until you know this medication affects you?”  Guess what, I actually know how these medications affect me, from recent, personal experience!  I actually know I can function, work and drive on 2.5mg hydrocodone.  It’s when I take 5mg that things get a little weirder.

The funny thing is this: I realized that the very fact that she is treating me like an addict (by doling out the bare amount needed to get me through to our next scheduled visit on the amount I’m telling her I’m taking now – not thinking that my pain may increase with more treatments – two more to go this week – and if I have to take more than we planned on, I’ll be stranded right in the middle of a 4-day streak when I can’t easily get to her – nice) – is actually making me act like one!  In order to get my needs met, I’m gonna get my pain meds from another doctor (because I don’t need to have this begging, bullshit conversation every week until the end of my radiation therapy)!  So, because she assumes I’m an addict and therefore is treating me like one, I am actually displaying doctor-jumping drug-seeking behavior…too fucking funny!

Of course, it’s not really funny, because that was one prong of a two-pronged visit wherein Dr. Sanghani completely lost my respect and trust.  She has now given me the strong impression that she really does not care what happens to me after she’s done with me.  And that’s fine, for her.  Not so much for me, since I actually get to live in my body (hopefully for another 40-50 years – yep, not a typo – if this treatment business does its job).  Part of that for me is what the girls look like and how I feel about them specifically, and me generally.

To that end, my RSurg has recommended against me getting a boost because it causes more damage, that she will be having to fix.  But Dr. Sanghani is focused on (and Only on) eradicating the cancer as best she knows how – side effects, temporary and permanent, be damned.  Don’t get me wrong, I want the cancer to be completely gone.  I”m not stupid, and I get what this is about.

And…

I also expect 40 more years of living after this treatment course is over.  I’m currently 46 years old.  That means I expect to live almost as long as I have already been here.  That’s a Long Time to deal with physical defects that could be avoided.  And, if I don’t come out of the other side of this feeling good about myself, healthy And sexy, then really, that’s not a successful outcome – it’s the classic quantity vs. quality of life question.  I want both.  Am I greedy?  Yes.  But wouldn’t you be too in my situation, if you thought you could have both?

So my problem with Dr. Sanghani is that the quality of life issue is not at all important to her.  She doesn’t have the same overall gameplan for my recovery as a complete person that I do.  She’s too focused on the tumor and/or the disease and forgets both of those are attached to an actual human being.

Whereas, my RSurg sees my outcome as a whole person.  She has been involved with this since almost the beginning – certainly before my first surgery.  Her opinion has been dismissed by other saying “of course she cares about how you look when this is done – she’s a plastic surgeon.”  What they don’t know is that that perspective comes from an understanding of breast cancer recovery as a unique blend of mind, body and soul, in a different way than almost any other cancer because of the physical disfigurement attendant to it.

Why do I believe she has my best interests at heart and I don’t trust Dr. Sanghani?  When I met my RSurg, it was the very first time since my diagnosis almost a month before, that I actually felt calm – I could take a deep breath.  I have re-experienced that ‘safe haven’ moment in each of my subsequent visits with her.

I knew also that she had pioneered a one-step mastectomy/implant procedure for breast cancer patients.  She is experienced not just with cosmetic procedures, but with reconstruction after cancer.  She called me (as did my CSurg seprately) to explain why she was not comfortable with and therefore could not do my reconstruction at the same time as my excision surgery – namely that if my CSurg did Not get clean margins the first time and my RSurg had already used my own tissue to do the repair, then my CSurg would have to go in and re-excavate the tumor bed in order to Get clean margins, thereby wasting all of my own adjacent tissue (it would have to be removed along with more edges of the tumor bed) and that tissue would be forever gone for reconstructive purposes.

Why is reconstruction such a big deal for me?  Please see “A Lesson in Volume.”  Let’s take a divet this size out of the front of your body and see what you think, eh?

Anyway, this made sense to me.  I understood it.  Although I would rather have had only one surgery (that would have been ideal, wouldn’t it?), I went into it accepting that I would have two or three (if my CSurg did not get clean margins the first time) and that I couldn’t even Schedule reconstruction until pathology on the tissue confirmed clean margins.  And I accepted it because I Trusted that both my CSurg and my RSurg had my best possible outcome – physically, mentally And emotionally – in mind when charting my treatment.  I trusted (and still trust) this about them because they had instilled this trust in me by how they interact (still) with me.  Dr. Sanghani hasn’t really done this in the same way – my calm last week was (apparently) a temporary reduction of defending myself against doctors who mistakenly think their relationship is about them and not about the patient.  <shakes head>

Side Effects:

– pain – more of it every week.  These days it can hit anywhere from the left side of my sternum where my ribs attach, all the way to past the midline of my body under my arm – and from almost up by my collarbone down to the inframammary fold – including my chest wall under Lefty and Lefty itself being just generally tender.  Lovely.

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