Home from surgery. I'm okay. It hurts. I came out of anesthesia really well actually. Eating normally, trying to keep moving around even though I am headachey and tired. Josh and I got Thai (I had drunken noodles, yum!), we went for a short walk afterward along fanno creek and through downtown Tigard, I sat outside to watch the sunset with Avalanche, I roasted some pumpkins, gunna bake a pie shortly, listening to holiday music and playing with Avalanche and drinking a lot of tasty tea to cheer myself up. I'm supposed to eat fiber and drink a lot of fluids. I want to write more cards but I can do that in the morning, it's starting to ache a lot even with the ice.

The savi scout placement sucked, I wasn't having fun at the breast health center, the imaging afterward was almost as bad as the placement - I am really developing a strong distaste for mammography. But surgery itself went smoothly. the IV nurse needed two tries to get a vein, that arm also hurts, she was so apologetic but she did really well, the valium helped immensely once I finally got some. Otherwise things went fine.

Looking forward to popcorn and fake beer and Matrix: Resurrections with Joshter on the couch in a bit. I only got halfway through last night (it's long!) and I'm thrilled to re-watch the beginning, it is so much fun. I love it. I love the director, I love the actors, several of my beloved Sense8 people are in the supporting cast. Keanu is love. So is Carrie-Ann Moss.

( spoiler in case anyone cares )

had a really nice time at the coffee shop. Mailed out seven more cards. Re-taught myself how to cut snowflakes. A favorite de-stressing activity. (mine are six-sided. it matters.)

had some collagen cocoa, current bread, and a bowl of split peas and veggies for dinner. Super tasty.

I need to start hydrating and prepping for tomorrow. Showering, fresh bedsheets, putting out my surgery clothes, I have to stop eating at midnight but will probably stop sooner than that.

Tempted to go dance. If I can get there early and just get an hour in? It might feel good to move a bit.

But it might be smarter to stay home. Keep writing cards and cutting snowflakes. It's so fun.

Does anybody want a xmas card? (L yours is already in the mail.) message me your addy if you like and I will try to get something out to ya.

I should mail my dad's letter to my brother, I realized after I did his card. But I don't want to put my return address on it. oof.

Hanne dropped off a gift for me, she is being such a cheerleader for me (she just finished her chemo a couple days ago), she's amazing, cheering others on while fighting such a hard battle herself.

Need to write to my customers to excuse myself from sparkles for a little bit, that's next on the list. A piece of chocolate as a reward for that work might be in order :) Oooorrrr, I could rally and bake some gingerbread cookies :D

I'm feeling very brave and ready for this, suddenly. It's easier knowing what I'm doing, rather than all that waffling, oof.

Having a really hard time deciding about surgery Friday.

...

Edited to add: Just doing a little more reading, if I were lower risk in general, less cancer in my family and less dense breast tissue, it would be fine to let this go. Those are the folks who are good candidates for waiting. But my high risk profile means it would be smarter to go ahead, from what I can gather. 5cm is the cutoff for absolutely not waiting, 3cm doesn't provide a lot of comfort, for me. I do have only a single lesion, which is good. I am hoping for just clear margins, no further findings, and being finished with treatment after this.

sigh.

I've decided to go ahead with it for now. If in a couple hours I really feel like this is the wrong choice, I can still reverse course. I can reverse course at any point until I get to the hospital, really.

...

There are so many conflicting factors in my head, and emotional difficulties. It's so so hard to settle my mind one way or the other, I keep flipping back and forth.

I have ADH - Atypical Ductal Hyperplasia. If the vacuum-assisted core needle biopsy had gotten all of the calcifications, they probably would have suggested monitoring, and not surgery. But since there are 3cm left of the "lesion" (clump of cells), they want to take out the rest and its surrounding tissue, not just to prevent it from growing into something cancerous, but also to test the tissue to make totally sure there is nothing else lurking in there, and to make sure it's all removed.

I have a 30% chance of developing breast cancer regardless of whether or not I get this procedure, so I will be closely monitored annually as a "high risk" patient for the rest of my life, regardless of whether or not I have this procedure.

There is a 7% chance this could develop into cancer in 5 years. 13% in ten years. It takes 25 years to reach that 30% risk.

But, I only had a 10% chance of ADH in my biopsy, and here we are.

So, part of me wants to go ahead on Friday, just to have peace of mind and make totally sure everything is out and we know what we're dealing with.

IF that tissue comes back positive for DCIS (basically stage 0 cancer or pre-cancer, depending on who you talk to there are different terms for this), there would be a drug regimen (testing for estrogen receptivity hopefully?) and radiation, and (unlikely) a lumpectomy to remove more tissue if the margins aren't clear (if there's any question as to whether there is more).

BUT. If I wait. There is a chance nothing comes of it. It could be the same in all my scans going forward, and I could avoid surgery altogether.

OR maybe get it in a few years.

OR maybe things change and I have to get it in 3 or 6 months, which would SUCK and ruin my summer.

There is no good time to have surgery.

The idea of saving myself the pain and trouble of surgery is very appealing.

But the fear of letting something unhealthy develop by leaving it be is worrisome.

My friends currently undergoing chemo or having already had it would advise me to do anything to avoid ending up there.

It's hard for me to go against the conventional wisdom of just taking it out to be certain it's nothing.

I have seen statistics that these excisional biopsies come back positive for DCIS more than half the time, but it's a wide range, and I don't know the details or factors.

Both surgeons at both hospitals agree it would be reasonable to wait, because my lesion is 3cm.

1cm would make me feel a lot better.

Over 5 or 6cm, they would not recommend waiting.

I'm in a grey area and it makes it really hard to decide!

There is sort of no right or wrong choice, here. It's an educated guess.

I have to sort of go on instinct?

Initially, I really thought I would cancel it. I wanted to save myself the pain and suffering, especially during such a stressful time.

But just putting off the inevitable sounds horrible. Both surgeons seemed to lean toward that meaning the surgery would happen next year, not never.

If that's the case, I'd rather just do it now, while I'm already prepared, already planned to take the downtime and the time off work, etc.

But part of me loves the idea of working through the holiday and taking all this fear and anxiety away and putting it on older-Sarah's shoulders. Maybe she'll be able to handle it better than me.

But is that being so so mean to my future self?

Or is it being protective and kind, since it's possible surgery is totally unnecessary and neither she nor I would have to go through with it.

It's soooooooooooooooooooooooo haaaaaaaaaaaaaaaaaaaaaaard.

Other confounding factors that shouldn't matter but do: Josh wants me to wait. (He hates how stressed we both are and wants some good time together sooner than later, we've been doing really poorly since the move.)

It's FREE right now. Because of what's going on with insurance. Who knows how much it would cost a year from now. Thousands, potentially.

I feel soooooo poor after buying this stupid house, so stressed about money, so this unfortunately feels like it matters when I know deep down my long term physical health and well-being is more important than a couple thousand dollars.

Honestly the other thing? Sort of selfishly? I want the downtime. I want to just sit and be still and cozy. I want people to back off and let me heal. I want to be forced to be gentle with myself. I want to rest. I want to be left alone. I want to sit and write letters and take long gentle walks through the forest and not work.

I want people to understand that something difficult and painful and serious happened to me.

I also want to work! I want to sparkle the crap out of everyone for Christmas. I want to hike and ski and frolic in the snow.

We have no snow on the mountain yet. Not at any elevation we can reach.

Josh is really hoping I cancel. My customers are hoping I cancel.

I love the idea of the release of not having to do all the prep and deal with dressings and incision scars and icing and painkillers and swelling and not being able to lift.

To just dance and bake and run around whenever the rain allows.

But will I be worried that I made the wrong choice and left cancer to fester?

But if I do it and everything comes back clear, will I be mad I did something terrible to my body that wasn't necessary?

No aerial for two months. :(

Unlikely, but what if I come out of it deformed?

It's soooooooooooooooo haaaaaaaaaaaaaaaaaard.

I've wanted to much for so many days/weeks to come and just sit and write but once I'm ready I'm always just so so so tired and sleepy.

I have a video visit with OHSU tomorrow and then right after another one with the breast health center, I might pull the plug on my surgery, depending on how all this goes.

I wanted to write out all my questions but I'm just too tired. I will have to do it in the morning, hopefully my head will be clear enough.

Trying for a lookout tower in the morning also. Will see how that goes. So far I've had very little luck with those. I might have to find another place to stay in that area.

Josh and I had a fight Sunday night. We never fight. He swore at me. This has happened maybe thrice ever.

I am just so stressed out about the surgery. Everything in my body is screaming not to do it.

It is not urgent. It is not cancer. I can wait. We can monitor. We can do it in one or five or ten or twenty years if/when it becomes a problem.

sigh.

Still zero interest in sex, that isn't helping things with the relationship. But I'm getting more used to the dreary empty meaninglessness of suburbia, and slightly more settled into the house.

I still don't like it here, but I hate it less. Avalanche and I have bonded over our enjoyment of the backyard.

I have been getting bigger and bigger attacks of vertigo, multiple times a day, it's starting to get worrisome. I think it is just stress.

I cry every day. Over mom, mostly. And the way she died. And the way she turned on me before she got really sick. The way she turned on everyone. Deep down I worry that I deserved it, that I deserved to be hated, that I was really that awful.

But then, I think about all the abusive ways my brother has treated me. And I have never told anyone that I refuse to be in the same room with him. I still love him. I still would help him in an emergency. I still talk to him when he asks. I just don't go seeking for connection. I am more superficial, only because he weaponizes my words if I give him anything with any sort of substance. But I would never dream of disowning him.

It's hard to imagine being a mom and doing that to ones own child, no matter how ungrateful or unpleasant you find them.

I just... I thought the world of her in so many ways. I also despised her in so many ways, when I was younger. I just didn't understand. I don't know why I was so mean and hateful. I guess because she was. I was mimicking. I didn't know any other way to be. How desperately I wish I could change the way she deteriorated, how I wish I could have softened her decline and eased her suffering and made the end of her life happier and longer. It's so complicated and torturous and unbearable to think about, and holidays amplify all of it to a deafening volume that I can't control. I was sobbing at work this morning, out of nowhere, it hit me like a sneaker wave from behind, five minutes before a customer was to arrive, and had to pull myself out of it and redo my eye makeup, it was awful.

I think the stress of the move to a place I hate and the stress of the holidays without parents and the stress of the surgery all at once is just too much for me. I need a break.