Tuesday, April 1, 2014

Never Stop Praying

Several months have passed since my last post, which was the first week of the New Year.  If my chemo-brain remembers correctly, I was still enjoying the afterglow of being pronounced cancer free, a feat that wouldn't have been possible without my family and friends encouraging me through months of chemotherapy and life changing surgery last fall. It is now officially spring, the time of year when Mother Nature and Old Man Winter traditionally engage in an atmospheric tug-of-war.  My fellow Arkansans understand exactly what I mean…sleet and freezing rain one day and 72 degrees the next.  Life can be just as unpredictable. 

On January 21, I met with Dr. Suzanne Klimberg, my breast surgeon extraordinaire.  It had been more than 90 days since she performed the bilateral mastectomy and it was time to check her handiwork now that the swelling and discoloration had subsided.  She entered the small cubicle and seemed glad to see me… or maybe it was just my chest, sans breasts, she was anxious to scrutinize. 

Dr. Klimberg gave me a quick hug then immediately opened the cape-like gown that was wrapped around my shoulders.  She began pushing on my numb nipples that she had skillfully moved and stitched to my surgically-designed “flaps” in preparation for the breast reconstruction that would soon take place.

“They look really good,” she stated as she continued to push and probe on the old girls.  There was a time when Dr. Klimberg and the other surgeon in my life, Don, were concerned that my nipples might not survive the trauma of being relocated and sutured to my skin.  She reassured me that all was going to be okay because my nipples were officially “in the pink.”

Emotionally, I was pleased with her prognosis but a little nervous when she informed me that I didn't have to see her again for one year unless her colleague, plastic surgeon Dr. James Yuen, “screws something up.”  I laughed out loud.  It was a vintage Suzanne Klimberg remark.  “What could he possibly screw up?” I asked the good doctor between giggles.

She assured me that Dr. Yuen is a phenomenal plastic and reconstructive surgeon - probably one of the best in the country.  He’s also chief of the plastic and reconstruction surgery division at UAMS, which speaks volumes about his skill and experience.

“You won’t even be able to tell where he tattoos your new breasts,” she said laughing as she opened my cape one last time to look at what was left of my ta-tas.  Tattoos?  Surely she was kidding.  I love that woman.  Her humor and skill with a scalpel made my destiny with breast cancer a tolerable experience.

A few days later, I was scheduled to see my oncologist, Dr. Issam Makhoul, for a follow-up.  Don and I waited nearly two hours before we were called back to see him. When you are fortunate enough to have Dr. Makhoul on your team of physicians, you learn quickly not to complain about the wait.

When Dr. Makhoul came into the exam cubicle, he inquired if I was experiencing any lingering side effects since completing treatment last September. Many people might think that once chemotherapy is over, patients no longer have aches and pains.  Not so!  Dr. Makhoul warned me to expect various issues for up to two years after the last dose of toxins.  In my case, I continue to have ongoing digestive issues, joint pain and two new problems – carpal tunnel syndrome and tendonitis in both wrists and elbows.  My wrists ache badly during the night and become numb, which disturbs sleep.  I have started wearing splints but it doesn’t help much.  Dr. Makhoul said based on other cases the pain and numbness would probably improve over time.  There is no question that chemotherapy can save lives; however, it comes with consequences.

Due to my ongoing colon issues, Dr. Makhoul scheduled a colonoscopy for me at UAMS on January 29 to make sure there were no signs of cancer.  In addition, he recommended that I have a PET scan, which is customary three to four months after chemotherapy and for several years, thereafter.  He requested that I make another appointment with him on February 11 to receive the results of both tests.

Don and I met with Dr. Yuen a few days after seeing Dr. Makhoul.  Our goal was to set a date for the reconstruction surgery.   I had only met with Dr. Yuen one other time and had forgotten how different his personality is from that of Dr. Klimberg or Dr. Makhoul.  He is very focused, doesn’t make casual conversation and asks few questions.  

When Dr. Yuen entered the exam room, he took a quick glance under my gown at the blank canvass Dr. Klimberg left for him to craft a Michelangelo-like masterpiece. His work would involve implanting expanders underneath each “flap,” which might also include a little structural engineering to support his creation.

“She did a nice job,” Dr. Yuen said while poking and prodding the deep cavity where my breasts used to be. “Well, just don’t screw it up.” I thought to myself remembering my humorous exchange with Dr. Klimberg a few weeks earlier.

“What size were your breasts before the surgery?” he asked.  Don immediately responded, “Just perfect.”  But Dr. No-Nonsense didn’t appear to be amused.  I reminded myself that this guy was going to be a tough audience. He continued with the same line of questioning and inquired if I wanted to remain the same size. “Maybe,” I told him, “but I would like to shop around, first.  Do you have a catalogue?” Finally, a smile appeared on his face. 

Marla leading a breast cancer fundraiser at the Arkansas
Governor's Conference on Tourism, 2014.
With calendar in-hand, Dr. No-Nonsense asked when I would like to schedule the reconstruction surgery.  As dates crossed my mind, I realized there was no way I could have surgery until after the annual Arkansas Governor’s Conference on Tourism – a state-wide event that I am responsible for planning and executing in early March.  Then Don piped up and blurted out, “After Derby Day – April 12.”  Don and I haven’t missed the final day of live thoroughbred racing at Oaklawn Race Track in nearby Hot Springs in more than seven years. Without hesitation, Dr. No-Nonsense reserved Monday, April 14, for my surgery. I was thrilled.  It had been a long journey up to this point and I could finally see the light at the end of the tunnel. 

Dr. Yuen instructed me to report to UAMS for blood work on April 10.  He told me the surgery would take approximately five hours and to expect an overnight stay in the hospital.  He warned me that the pesky drains would once again be a part of my attire for about ten days following the surgery.  Oh, goody.  The drains…  $%*7&@#.  And just like that Dr. No-Nonsense left the exam room. 

Over the next two weeks, I had the colonoscopy, followed by the PET scan.  Both were uneventful.  Don and I met with Dr. Makhoul on February 11 for the results of the tests.  Dr. Makhoul was busier than usual and seemed a tad bit harried when he entered the room.  He immediately sat down at the computer and pulled up my chart.  He indicated that the colonoscopy was clear and there was nothing to worry about, which was a great relief. 

Marla with Andrew McCarthy, actor, director, and award
winning travel writer, at the Arkansas Governor's Conference
on tourism 2014.
Next, he pulled up the PET scan report.  Dr. Makhoul very matter-of-factly told me that there was a one centimeter spot on the stem of my right lung.  At that very moment, one touch of a bird’s feather would have knocked me to my knees.  Don and I just looked at each other.  Neither of us could talk. We were stunned at what Dr. Makhoul was telling us. Before I could collect my thoughts and ask questions, Dr. Makhoul immediately cautioned me not to jump to any conclusions.  He said the spot was more than likely scar tissue from a recent bronchil infection.  From your lips to God’s ears, I whispered under my breath. 

Don informed Dr. Makhoul that the reconstruction surgery was scheduled for April 14.  I was still speechless.  Dr. Makhoul quickly put a game plan together.  He ordered a second PET scan to be performed the week before the surgery. If the spot shows any increase in size or shape, the surgery will be cancelled and a biopsy performed. 

Before Don and I left the exam room, Dr. Makhoul made me promise not to worry about the result of the scan.  “I have seen this hundreds of times,” he said reassuringly, “and it usually turns out to be nothing.”

Don and I didn’t say much to each other after we left Dr. Makhoul’s office.  I could tell he was alarmed; it was written all over his face.   I asked him to be straight with me and share his thoughts.  Don didn’t deny that the location of the spot on my lung was his biggest concern. I appreciated his candor.  That’s why I am so grateful that Don is not only my loving companion, but he’s a great medical sounding board, as well. 

Needless to say, there is a proverbial elephant in the middle of the room, and it will continue to be until Don and I see Dr. Makhoul again on April 11 for the outcome of the second PET scan.  Whether or not I have reconstruction surgery on April 14 is still to be determined and an example of why cancer survivors never stop praying, nor should their friends and family members. 

Ironically, it was about this same time last year when my life changed forever.  I learned quickly that prayer is about the only thing that can move that elephant from the room.