Late last week, I had a few/several good cries as I wrestled with the thought of deciding between a lumpectomy and a mastectomy based on the results of a re-stain of the second lesion in my left breast — the one that's near my known tumor, but the docs couldn't tell what kind it was.

No matter how I weighed the pros and cons of one surgery vs. the other, I felt hopelessly stuck — scared that if I didn't do enough, my risk of recurrence would be too high or that if I did too much, I'd regret putting my body through more hell than it needed to endure. Turns out I don't have to make that choice anymore. I'll need a mastectomy because the second lesion in my left breast is cancerous: ductal carcinoma in situ, or DCIS, not the lobular kind (LCIS), as the results of the biopsy initially suggested. So good riddance to that hopelessly stuck feeling. Now the decision I'm mulling is whether to get one or both breasts removed. Zoinks. Big decision. Turns out I have some time to think this whole thing through, and I feel super close to a game plan, after a follow-up consultation with the surgeon on my Seattle Cancer Care Alliance team: get my left breast removed right away, leave the right one alone while I go through chemo and radiation, then — if I still want my non-cancerous, or not-yet-cancerous right breast removed after treatment, I could get it removed and reconstructed during the reconstruction of my left breast. Choices, choices ... Gotta say, it feels strange to give you all these updates in such great detail. But writing about this is therapeutic for me — and on a very practical level, it frees me from having to explain all this over and over and over to the many people in my life who are wondering how this shitshow is going. Next steps:

1. Surgery on Thursday, July 30 (send ass-kicking vibes first thing in the morning).

2. An overnight stay at the hospital (Overlake in Bellevue).

3. About two weeks of downtime while I heal up.

4. A week with my dear friend/bridesmaid/former partner in writing crime during my newspaper days, Roxanne Martin, who's flying up from California to be here for me after this first battlefront.

5. Physical therapy to do all I can to prevent lymphedema — major arm swelling that can be a side effect of getting all the lymph nodes in your underarm scooped out.

More about those lymph nodes ... I haven't emphasized this much in my previous posts, but my SCCA second opinion team helped me get over the lymphedema fears that made me wonder if I could get as few nodes removed as possible — think axillary dissection "lite." They convinced me this would be a bad idea — SUPER bad — because knowing just how many lymph nodes are positive for cancer is SUPER valuable information about the risk that my breast cancer has spread anywhere else in my body. Not a pleasant thought to consider, but if there's any time to leave no stone (or lymph node) unturned, it's now. Still waiting for an OK to get a PET/CT scan that could show if there are any other signs of cancer beyond my breast and lymph nodes. A pathologist will slice and dice all the lymph nodes taken out during my surgery. If I have three or fewer lymph nodes that are positive for cancer, I might be able to avoid getting "red devil chemo" with Adriamycin, a whopper of a cancer-fighting drug with a couple side effects that I want nothing to do with: cardiomyopathy (serious weakening of the heart) and ... wait for it ... leukemia. Yes, that's right. A cancer drug that can give you cancer. It doesn't happen often, but it happens. My mom soldiered through red devil chemo and did just fine. But as a woman in my 40s with breast cancer, I'm all too familiar with that feeling of being in the single-digit odds of getting this pain-in-the-ass disease so young. So you can understand why I'm hoping that if I can skate past the red devil and get a "kinder, gentler" chemo, I'd be grateful. That's a decision I'll make some other day. For now ... I'll be spending the next week mulling the single vs. double question, and whether I'll say bye-bye to one or two breasts next Thursday. I'll be weighing lots of the issues outlined in this Fred Hutch essay by Diane Mapes, one of the intrepid breast cancer survivors I've connected with in recent weeks as I slog through all these decisions, decisions, decisions. Many of you have very kindly reminded me, "If there's anything we can do, let us know." If I took all of y'all up on that kind offer, I'd need a full-time assistant with access to Sean's and my work and family calendars to book all the help you want to give us. That'd be one heck of a big job ... too big for any one person to take on. We're getting close to figuring out a game plan for posting tasks in CaringBridge that you can sign up for, however/whenever you want to help. Stay tuned. And as always, thanks so much for being here for me. Whether you're near or far, it means the world.

#CaringBridge #cancer #SCCA #reddevil #FredHutch #lymphnodes #mastectomy