12. Livers n Cords (mmm)

Hello everyone, and welcome back. I am exactly one month out from my mastectomy and ALND surgery. My incisions are healing very well, and I have been in for 3 of my 4 expander fills. My remaining pain is limited to the bottom corners of the expanders cutting into muscle and/or areas of my ribs, mostly on the right side. It feels like what I would imagine a pencil being stabbed into the inner, lower side of the breast where it meets the rib. I am starting to be able to sleep on my side, but because of the expander pain I usually can only sleep in that position for an hour or so before moving onto my back again. Tylenol helps somewhat, but not entirely. I can’t currently take Ibuprofen since I am on a blood thinner for the clot in my heart, so I am trying to figure out the right combination of Tylenol and CBD to help with the pain that seems to increase in the afternoon and at nighttime.

The fills themselves are not painful, and usually go pretty quickly. The PA who has done the fills finds the expander port using a magnet, and then injects sterile saline with a needle and syringe. So far they have injected about 75 cc at each visit, and 100 cc were put in at the time of surgery. They do this in a stepwise fashion so that it allows my skin to stretch for a week in order to accommodate each subsequent injection of saline. It feels tight for the first day or two, but the actual skin stretching isn’t nearly as painful as the edge of the expanders cutting into the muscle or along my rib. Luckily, it doesn’t seem to be getting worse with more saline injected; it seems to just be the positioning and suturing of the expander to my chest wall. Hopefully this will lessen over time, since I likely won’t be getting reconstructive surgery for about a year (I’ll have to get through radiation, more chemo, and 4th year of vet school first).

I have developed something called “cording”, also known as “axillary web syndrome”. This is a common post-operative side effect following an ALND surgery, and results from lymphatic vessels hardening after being severed during surgery. It feels exactly like what you’d picture based on the name- a tight bundle, or web, of cords that extends from my upper pectoral muscle to anywhere from my mid-bicep to elbow, depending at which angle I am holding or stretching my arm. It feels like a thick, extremely tight guitar string- they are STRONG. I was referred to physical therapy, which has been starting to help quite a bit. So far, I’ve had two PT appointments where we do a number of different stretches, range of motion exercises, fascial massage, and cupping. I am also supposed to do 10 min 3x a day of specific stretches at home- I’ve been bad about doing it 3x a day every day, but on the days I don’t have a bunch of appointments I’ve been managing to get most of it in. It sounds like if I stick with PT, the cording should mostly be resolved in the next few months. It may recur throughout my life, but right now is the worst that it should be. I love my physical therapist, and she has taught me a lot already.

So, onto the big stuff…as many of you know from social media, the latest bad news in this wild reality I’m living is that the mass on my liver lit up on PET scan a few weeks ago. This led my primary oncologist to change her estimation of this being a malignant mass from 75% to 95%. Of course this wasn’t the news we were hoping for, but it’s the news. So, since my oncologist wants to take the aggressive approach still with curative intent, she strongly suggested that we move forward with a liver lobe resection, also known as a hepatectomy (“hepatic” being the root word referring to the liver).

Her reasoning for this approach (rather than doing another biopsy) is due to the fact that the last biopsy came back inconclusive, and if we were to get the same indeterminate results again, we’d just continue to push my radiation and chemo back again, which risks recurrence of my breast cancer. She also didn’t want to just wait and watch it, since if this is malignant, there is a chance that it could spread. Brandon came with me to this appointment, and he and I both agreed right when she left the room that we were totally comfortable moving forward with the surgery. At this point this mass has given us so much confusion, and although it isn’t the typical shape or size they’d see with a breast cancer metastasis to a liver (usually they’re smaller and in several different areas rather than one large mass), it’s just too ominous not to remove at this point. And, with her prediction of 95% chance that this IS a malignant mass, I feel at this point that it would be irresponsible and risky not to have it removed.

Of course this is terrifying, but at this point I don’t really have any other choice. And, the good news is, it’s isolated to the left lobe of my liver, so the surgeon will remove just this lobe and won’t have to touch the right (larger) lobe. This means I’ll have about 30-40% of my liver removed, but should have 60-70% remaining after surgery. The liver has regenerative capacity, but when I met with the surgeon, she said that my liver may well not even need to regenerate since having about 70% left should be sufficient to carry out the usual liver duties:

• Bile production and excretion
• Excretion of bilirubin, cholesterol, hormones, and drugs
• Metabolism of fats, proteins, and carbohydrates
• Enzyme activation
• Storage of glycogen, vitamins, and minerals
• Synthesis of plasma proteins, such as albumin, and clotting factors

In regards to the oncology surgeon who will do the surgery, she is basically a goddess. Brilliant, kind, and beautiful. I totally trust her recommendation and she seemed extremely confident that this was the right course of action. She and my primary oncologist talked at length about the size of the mass (it’s big) and whether doing surgery now vs. later would be best, and they both agreed that doing the surgery now is much better. She said she hasn’t done a hepatectomy like this very often in young patients, just a few, but does it frequently in elderly patients, and even those patients recover very well from it. She said that the younger patients she has performed this surgery on have also recovered very well from this type of surgery. I’ll be in the hospital for 2-5 days, and total recovery time is estimated to be 4-6 weeks. However, I’m hoping that I’ll feel relatively back to “normal” after 3-4 weeks (my recovery from the mastectomy makes me hopeful for the lower end of this time frame).

The surgery itself will entail going in through my abdomen (the incision will be under my ribs on the right side), ligating a bunch of vessels that feed the left lobe, resecting the lobe while cauterizing the edge of the right lobe, and then possibly putting in a drain (only if my gallbladder gets punctured, which she doesn’t anticipate happening).

The surgery is on April 1st, so I’m hoping because it’s April Fools day this means that the mass will come back as benign 🙂 As with this entire experience, I am going to hope for the best, but be prepared for the worst. If it is malignant as my oncologist suspects, then we have taken it out and we pursue further treatment (radiation and chemo) to try for curative intent. What that looks like for now is what we would have done whether or not this liver mass reared its ugly head, and includes radiation starting in the next few weeks as well as further chemo, immunotherapy, ovarian suppression, and endocrine therapy. So, although this could come back as malignant and mean I am Stage IV, at least it doesn’t drastically change any treatments in the near future (at least that I know of at this point).

I have one more fill appointment, one more physical therapy appointment, and a radiology consult appointment before surgery on the 1st. I have been staying as active as I can with walks, modified circuit workouts that avoid too much arm stuff, and just general movement throughout the day as much as I can. My wonderful and beautiful and amazing friend, Olivia, came out to visit last weekend which was fantastic. She is such a light in my life and on top of dinner, hiking, dog walks, and coffee dates, we started to plan a trip together for post-cancer and post-graduation. I am so lucky to have had her as a boss, a mentor, and now a dear friend.

Some other good news which I just received today: Frankie’s lesions came back as benign! I found a few dark spots on his lip last week, and due to him having a malignant melanoma on his snout last year, we were very suspicious that these new lesions were malignant melanomas as well. Oral melanoma in dogs is very aggressive, so I was pretty worried. But, he had them removed with a dental cleaning the other day, and they just came back as benign melanocytomas. YAY! Some good news that we desperately needed around here. An expensive diagnosis, but I am so happy that they’re off of there, he got another really thorough oral exam, and we don’t have to worry about him also having cancer. Whew.

Ok, I think that’s all I’ve got for now. There are some lingering chemo side effects that have been annoying lately, but I don’t need to go into detail on those since they seem to be so minor compared to everything else going on. Mostly just allergy-related nonsense (oh, and the hot flashes are still a fun rollercoaster each day and night). The clot in my heart is still there but I’m still on the blood thinners so this too has kind of been pushed to the background as of late. All in all I am doing pretty well and am just ready to get this next surgery out of the way. Thanks as always to all of you for being interested in this journey and for following along. It means so much to me and to my family. Sending love and (non-cancer) doggie kisses to all of you!