Update 11/26 and sick leave needs anticipated

Hi all,
Well it was a great weekend being able to sing on Saturday as well as see my brother, father and his wife. We were able to have some days together here in the valley after Thanksgiving, and wow, do I have a lot to be thankful for and I'm so grateful for your prayers.
I still feel wiped out and not "normal." I mean, I just don't have the stamina that I had before and today was really hectic with family and phone calls and a meeting and trying to take care of lots of things and it was too much. Isn't that funny, something people going through their daily routine do every day and it was too much for me. I mean, I got home and I was spun out and exhausted. It was all I could do to heat up a bowl of soup and eat a couple of pieces of See's candy that my dad and his wife Ellie brought me. I was ready to jump into bed about two hours ago but wanted to do a post first. I just am continually astounded how out of it I kind of feel. As it was with chemo sort of knocking me down a peg each time, I feel like the fight backc to physical "wholeness" if you will, is just going to be a daily persevering process and i have to not berate myself for not being back to normal yet. It's going to be awhile and that has to be okay. I'm learning...
Next week, I go back to LA for more physical therapy and another visit to the plastic surgeon. As it is now, I am having surgery again at the end of January to put in the implants and it will take a bit to recover from that since I've just had surgery once and am working on rehab from that. So, my sick days run out in February from the Catastrophic sick leave bank, and I'll have to request days be donated from my colleagues. As for how that process works, I've e-mailed Mike Duran for his direction since he will leave his post as the union president in about a week or so to take a post on the school board here in Desert Sands USD. Anyway, as it looks now, I'll still need second semester off so I'm praying for the support that I'll need to do that.
That's all for now, I'm going to bed.
love you,
julie

Update 11/22 radiation oncology consultations..

Hi all,
I went yesterday to a few appointments in LA and then had one here today in the desert. As I mentioned in my last post, I was really thrown for a loop when my oncologist Dr. Dreisbach suggested that I consult a radiation oncologist, becuase I wasn't expecting to do that since Dr. Silverstein basically said I wouldn't need it. However, at the same time Dr. Luke suggested that I look into radiation he also stated that it would be controversial since the data for someone like me isn’t conclusive. At that point I mentally had kind of a jolted out of a mindset of “rehab” and recovery back into marathon treatment mode. Actually, it was like he was talking to me but I was processing the nonverbal informaiton and just the impact of him telling me I might need radiation when I had already mentally switched to recovery mode. However, after the appointment, and wrestling with it, I finally got to the place where I just said okay, God, whatever you have planned for me, that’s what I want to do and then it was easier to hear what I might have to hear. It was either that day or the next (probably the 20th) I was reading in Proverbs 20 and both verses 12 and 18 just seemed to leap right off the page of my bible and speak to me about the situation, which is so awesome because I had asked friends to pray for wisdom, and both of these proverbs just seemed to speak right to it.
Pr 20:18 "make plans by seeking advise if you wage war, obtain guidance."
Pr 20:12 "ears that hear and eyes that see--the Lord has made them both" These two verses are exactly what I'm doing is waging war on the cancer and it spoke of getting guidance and advice so that I could make plans. It was just what I needed to hear to confirm my pathway of seeing the doctors and listening to what they had to say and then listening to God about it all. It was great becuase it reminded me that God really is in control of this whole thing.
Anyway, so I went to LA yesterday and saw Dr. Sherman for my third fill of the expanders and then went to see the radiation oncologist at USC, Dr. Streeter, and it was a great meeting. What a great guy very personable and knowledgeable. The whole team there is just great. He was very informative and thorough and his opinion is that I do NOT need radiation, but that I would need to make sure that my follow up is good (i.e. some regular MRIs to check to make sure everything is fine). It was HUGE to me that he was firmly in this camp. I mean, we talked about the data and he gave me a copy of the most recent study on the matter and talked about some of the prior research and I had none of the indications that would make radiation seem to be a benefit. The costs (personal, physical) of doing it would outweigh whatever benefit I might receive from it. Namely, the greater chance of lymphedema considering that I had 50 nodes removed, in addition to complications with the reconstruction, etc. as well as other things.
Okay, so on to seeing Dr. Khanna this morning here in the desert. At last I spoke to her, she was leaning toward doing radiation, but when she looked at the final pathology from my surgery, she agreed with Dr. Streeter and said that, while there is some controversy, I’m NOT a candidate for radiation. I was surprised becuae I really thought that she would suggest it. So, as it stands now, I don’t need it. After I got dressed I did a little jig in the exam room becuase I was so happy! There is still one more doctor in the valley that I’m going to consult just to bring a final confirmation to the other two doctors, and even if the third were to present a convincing case for it, I probably won’t do it, since the risks outweigh the benefit. I just want to be able to really put the matter to rest and be able to go back to Dr. Luke on the 8th of Dec and share the concurring opinions with him.
However, regarding follow up, Dr. Khanna did suggest that I follow up with a PET scan (a PEt scan picks up actual cancer in the body whereas MRI is very sensistive and picks up both cancerous and benign tissues so it can lead to undue biopsies at times) rather than MRI because the risk of distant metastases might be greater than it recurring locally. So, I’ll bring these ideas back to Dr. Dreisbach, my medical oncologist, when I see him on December 8th for another infusion of herceptin. I’ll also be starting Tamoxifen shortly thereafter I would assume.
So, in the meantime, I’m working on my own little rehab world of exercises, scar massage, naps doctor appointments, reading research, trying to keep up with communicating, participating in worship etc. It’s been great to be able to spend time with family too as I go back and forth to LA. My brother is in town and will be here in the desert this weekend and my dad and his wife will also be down for the weekend so I'll get to see them since they are r&r - ing in Palm Springs until Monday.

I just thank God that He does hold all things together (1chrn 29:11)
Happy Thanksgiving!
Julie


Happy Thanksgiving!!
Julie

Update for Monday, November 20

It was so great to see everyone at church on Saturday night and there were so many people that I didn't get to hug. I hope to do that next week. I'll try to go to Sunday video cafe service as well next week. I wasn't up to it yesterday and I really wanted to do my own bible reading at home and do my exercise regimen. I took it really easy yesterday and I'm glad. It's so funny to me becuase I have my best energy in the morning pretty much so I find that I'll make a list of a whole bunch of things that I'll want to do and by the afternoon, they just don't happen because I run out of steam. However, on the flip side I am getting better at listening to my body and if it needs a nap, it gets one, even if it's just to lay down for 20 minutes and not even sleep, but rest.
I did manage to make dinner for myself last night so that was good and now I have some chicken left overs for the next few days.
Regarding radiation, I forgot that I had bookmarked a study online that was actually a meta-analysis (basically a synthesis and critique of other studies) on post-mastectomy radiation. It does appear that it is helpful and reduces the risk of local recurrence(meaning in the chest wall, scar or in the nodes nearby) and it seems that the absolute benefit is anywhere from 8-20% reduction in that risk depending upon which group of data you look at. There are also some statistical risk factors that they outline according to how many positive nodes you had, what size the tumor was, whether or not it was estrogen sensitive, etc, and the data does take into account a person that has had chemotherapy and it just examines the benefit of doing radiation in addition to the chemo and the surgery. It also shows that there is a benefit to doing the radiation even if you are node-negative (that is no positive lymph nodes). Apparently from what I read, the greatest risk of recurrence is in the chest wall (If it does reoccur,70% of the reoccurrences happen here) follwed by the scar area, and then the supraclavial/infraclavicular nodes (10-20%) and then lowest in the lymph nodes (5-10%). I think reading this study shed some light on the radiation question, though this review of studies was published in 1998 so the data is older and the radation techniques were different (I'm going to make the assumption that they've improved). I'm interested to discuss the data with the radation oncologist at USC tomorrow (Dr. Streeter) and see what he says and pick up some more literature on it. It's kind of funny because in my undergrad major I had to do meta-analyses of other studies several times, so it was kind of fun to read all of the literature and make sense of it. I really do enjoy that kind of thing, and be able to understand what it means when they say p<.005 versus p<.001 becuase it indicates the strenth of the statistics that they cite. Anyway, it was helpful to read it and have some numbers to think about....However, I am asking Jesus to show me His wisdom and what path He has for me. I pray that Jesus would show me which way to go so that I can walk in it.

Tomorrow I go to LA to see Dr. Sherman again at 11am for another fill up and then right after that I'll go to see Dr. Streeter (radiation oncologist at USC mentioned above) for a consultation at 1:30 and then after that I'll go to see my physical therapist Jennifer at 4pm in Pasadena. After that I'm sure Ill be wiped so I'll go to the Remy's and stay with them that evening. My brother will be in town for the whole week so I might see him Tuesday night, but he will also come out later in the week to the desert. Wednesday I have an appointment with Dr. Khanna here at Curci Cancer center at 11am for a follow-up consult with her.

Thanksgiving is going to be different this year for our family. Normally it is our big holiday as a family but my grandmother is ill and in the hospital as well as my cousin's daughter is getting her tonsils out the day before Thanksgiving so, instead of going up tot he mendocino coast as we have done in the past to gather together, we are splitting up. However, one cool thing is that my dad and his wife Ellie are going to get away from SF for a few days down here from Friday to next Monday so I'll be able to see them a bit while they're here, which is nice. So my brother will likely stay here with me next weekend a night or two so that we can spend time with Dad and Ellie together.

Anyway, it's time for me to work on my arm exercises again...
Please pray for wisdom so that I would make the right decision regarding radiation.

My next post will likely be on Wednesday so I can bring you all up to date on the doctor visits.
Thank you!
Julie
p.s. Thanks to Linda Matsko for helping me load my keyboard in and out of my car at home and to Chris Jacobsson for the livestrong t-shirt! I'm going to wear it to the gym this morning :-)

Threw me for a loop - radiation?

Hi all,
I went to see Dr. Luke today to discuss my final pathology report from the surgery and the next steps in the treatment plan for me. I expected to discuss the fact that I'm going to be on Herceptin until next August, and that I'll need to go on Tamoxifen. I also expected to talk about lymphedema somewhat, but since they had such an extensive dissection of the nodes, I am at a higher risk for lymphedema than others that have had regular dissections. That was all fine, I mean, there are just some limitations for me in that regard. However, when he brought up the subject of radiation and suggested that I follow up with a radiation oncologist I was shocked, since in my discussions with Dr. Silverstein at USC he felt I did NOT need radiation and/or that it was doubtful that I would need it. Dr. Silverstein's view on this is that the general protocals for radiation oncology are that if there are 4 or more positive nodes, they radiate and if there are none, then they don't. It's a little iffy if they find 1-3 positive nodes. So, this is why Dr. Silverstein's view was as such. However, in discussing the pathology results with Dr. Luke (none of the 50 nodes removed were positive) he said he had a hard time stating that I didn't need it, yet stating that it is controversial since there isn't a lot of data on this for people in my situation and that a second opinion from a radiation oncologist (I'll see two or three is what I'm thinking) would be a good idea in this case. As for why Dr. Silverstein's opinion might be so different is that he is a surgeon, and Dr. Luke is a medical oncologist, so they are not specialists in radiation oncology just as Dr. Silverstein and radiation oncologists aren't specialists in chemotherapy. I'm just concerned, however, that when I do go to see a radiation oncologist they're going to recommend the radiation, just as if I were to see a surgeon before I saw a medical oncologist, they're going to recommend surgery because each professional believes in their approach to treatment of course. So, I can go and collect information and what data might be available, but I'll be honest, I'm just not sure I want to go through radiation unless there is a good reason to do it. I mean, if the tissue is fine, I don't want to damage it especially for the long term and have issues with the reconstruction becuase it will make the skin more leatehry and less elastic, etc. I just think that, mentally, I was not expecting to hear this from him, so when I did, it really threw me for a loop. I mean, I was ready to start focusing on recovery and moving on to the next phase of life, but now I feel like htat may be put on hold...Well, I'm back in fact finding mode, and have an appointment next Tuesday when I'm in LA to meet with a radiation oncologist at USC since I have to go there anyway to see Dr. Sherman and I have physical therapy in Pasadena later that day. I'll also follow up with Dr. Khanna here next Wednesday. I know that Dr. Khanna already feels that radiation is something that should take place, since that's what she said the first time I saw her. Now, once she knows the pathology, that may elicit a different response but I don't know. I will also probably see Dr. Massek (spelling?) because he is closer and it would be nice to not have to drive to Eisenhower every day if I do need to do radiation. It seems that it may just come down to a judgement call that I'll have to make and decide. Please pray that I have the wisdom to make a good decision. God has been so gracious and wonderful to guide me in every step of the way with the health professionals, and I look forward to how He is going to work this out. So, although it kind of threw me off a bit, I'm just going to investigate and collect information and then prayerfully decide. I just pray that God would show me his wisdom in this.
I also went to physical therapy locally today and, I have to say, it was quite different than the therapy sessions that I had been to in Pasadena. In fact, they call the therapy here Occupational. I'm not sure I understand the distinction but the session was different. The therapist spoke a lot about lymphedema and prevention of it (becuase once it occurs, there is no cure there is only management of it). She took several measurements of each arm to establish a baseline and also to detect any differences. My right arm is 1/2 -1 cm larger in circumference in some places but she didn't feel it was worrisome, which is reassuring. Also, the physical therapist in pasadena did actual work on my trigger points and massage to help the ligaments that are tight to loosen up. The therapist here did not do that. So, it was just different. Anyway she encouraged me to do the exercises three times a day, so I'll start to do that, and I'm sure I'll have to be diligent to fit them in, like make an appointment to do them at certain times. But hey, that's my full time job is rehab anyway...well at least until I find out about radiation....
Thanks for your prayers,
Julie

I'm home :-)

Hi everyone,
I arrived back home yesterday in the afternoon after physical therapy and pretty much left everything in the car and just came in the house and went through the mail and crashed. Yet, I'm glad to be home and sleep in my own bed and be able to e-mail more regularly, etc and get into a restoration routine here. I mean, It feels good to be home but a bit surreal. I have even had some tears. I'm not exactly sure why but I think that I'm being too hard on myself because I thought I would be in a much stronger place when I got home, but what did I know about surgery ? I mean, I know I'm doing well because that's what all of the health professionals say that I'm working with and they say my progress is really good. I guess I just set high standards for myself and the realization that I'm not where I wanted to be when I came back, energy wise and physical strength and all was a little discouraging. I think I'm greiving a bit and I'm not sure I understand it all yet. I just know that it was a bit teary yesterday and this morning. I'm also just so grateful for the Remy's (aunt and uncle) love for me and how throughout my life they have always extended open arms to me even though they aren't my parents. I have truly experienced the love of Christ through them even though they haven't accepted Jesus into their hearts to live for Him. I am so grateful for them that the word grateful is so bankrupt at expressing it. They are true treasures and I pray that they would ask Christ into their hearts and see what a wonder and fullness it is to live for Him. I'm just amazed how true it is that God is truly in control of everything and He is the ruler of all mankind and he uses everyone whether they know it or not, to show who He is. Wow.
Well, I'm having my morning cup of coffee at the moment and I'm really enjoying that, and then I'm off to the gym just to walk and do my stretches and arm exercises with the thera-bands that I have. I guess, bottom line, is that it is okay to be slow, to be still, to rest. God is the author of rest. He said it is good, so I'll go with that. I'm learning constantly how to listen to what my body will and won't do. It's really a daily thing becuase there could be one day where I make a lot of progress and the next day maintain that or have a little more, but then the following day I have to do less or rest more and I'm learning that it's okay to do that. Proverbs 3:3-5 comes to mind about trusting in the Lord with ALL of my heart and leaning NOT on MY [emphases are all mine] understanding but in ALL of my ways to acknowledge him and HE will make my paths straight. When I think that my ways are far too circuitous and indirect, Christ has a greater plan. So I will trust in him and give thanks and be grateful in ALL things whether good or not good, because no matter the circumstances, God is love and He is good and I know that in my knower.
One foot in front of the other trusting God to lead me on level ground in the process of this "remodel"
Love,
Julie

Update...day before venturing home!

I had saline fill #2 today and, although they were planning on only 60 cc (1/2 of last time) they were able to do 100, so that means that I might have fewer trips to LA until they are at the size they need to be. Dr. Sherman and his team are really great people and I'm so glad to be in their care. In addition, I really like this physical therapist that I'm seeing up in Pasadena. Her name is Jennifer and she has been sooo helpful. I get to see her tomorrow and I'm really looking forward to it. Of course, she is very encouraging about my progress though to me it is slow and I am more stiff after today's fill, but it's one of those things where I have to do the exercises every day and twice a day to be optimal. It's challenging sometimes becuase my body is just basically sore all over and sometimes, honestly I just feel like taking a nap. Speaking of naps I really need to have one once a day. I mean, this past Sunday I was invited to a Laker game so I couldn't get a nap in andI had to plan for it (like no aerobic workout or that kind of thing in the morning) and just went to the farmer's market in Alhambra with my aunt in the morning (which is really cool becuase everyone there pretty much cpeaks some variation of chinese and we are in the minority I love it)and then did my devotional reading and prayers and just relaxed a little bit. Anyway, the game was amazing. I mean, just to walk through Staples and catch a glimpse of them warming up on the floor (we got there early before the game) and to see Kareem on the side just watching on as Bynum warmed up. It was pretty cool. I wasn't even a basketball fan before this other htan I had been watching the Lakers and Clippers games with my aunt and uncle because they are big fans (also of UCLA and the Dodgers, too). Anyway, it was cool. But what I realized was that I really need to have a nap every day just to survive basically. I can only plan to do one thing a day and any more than that is too much. For example, yesterday, I had physical therapy in the latter part of the morning and that, plus the workout I did before it was about all I had energy for, and that is fine with me. My job right now is rehab and everything else has to come second to that. Today after my appointment with Dr. Sherman I had planned to see my good friend Michelle Brandes. She is such a great friend and I have always appreciated the time that we spent together when we lived in what we called the "ghetto" on Panorama drive in palm desert. It was a sweet time of change and challenge in our lives, but as usual, God was always showing who he was by working in people and it was thrilling. Anyway, she was an integral part of Keith Green's ministry and has such incredible stories from that and church plants that she has been a part of. Her friend recently suggested that she write a book and I hope she does. Anyway, the point of this was that I was so excited to see her but I was so wiped. f course, when we got together I was totally jazzed and we had so much catching up to do, but I have to say that after I got back to the Remy's (my aunt and uncle's last name) I just crashed out. I was totally wiped. So that's what I mean that I can only really do one thing a day or it's too much. I have to have down time or it doesn't work.It was so wonderful to see Michelle and hear about what God has been doing in her life and to encourage and to be encouraged. She has has several surgeries and had a lot of great wisdom on this. We also share the fact that the two of us come from Jewish backgrounds so there are just some fun inside family kinds of things that we can crack up about becuase of that common bond. Oh, it was wonderful to reconnect with her and I will try to do again as I get back to LA again....and I'm so looking forward to seeing everyone at church again. I'm excited to get back into music as well..of course as stamina permits. Look forward to seeing everyone this weekend. I have physical therapy in the morning and then I'll drive back to the desert right from there. Wahoo!My aunt and uncle have been amazingly gracious and so wonderful to be with . I have learned a lot from them and about them while I've been here and it has been a sweet time in that way. I've always regarded them as my second set of parents and sought out my uncle's wisdom in many matters. They really are a treasure and I'm grateful to God for them.See everyone soon!!Love, Julie

Well, not anything super stunning to report today, just more of the steady progress. i was able to get my right elbow all the way down to the floor with my hands clasped behing my head, which is huge. I was stuck at the 45 degree mark for about a week. I can feel the taught soft tissue is becoming more pliable (with regular work of course) so it's really encouraging. I took my longest and most vigorous walk yet, and did some other exercises afterwards in addition to my arm exercises for mobility and it just felt so good and was so encouraging that I had so much energy. I didn't even poop out when I got back. The sun made an appearance and warmed everything up nicely here and was filtered throught the old oaks lining the streets. It was beautiful and just so encouraging to be able to use my muscles and go as far as I did and as vigorously as I did. Yesterday I made it through the day without a nap which is pretty incredible. I mean, I rested for a bit, but nothing like the 2hour naps that I had been needing to take every day. I guess I'm getting stronger. yay!!Thinking of everyone this weekend at church Saturday night and Sunday morning.Love to you all, Julie

Friday

I went out to dinner with my aunt last night and it was fun. It was the first time I had worn my wig since before the surgery and my aunt and uncle hadn't seen it before. I even put some makeup on and some regular clothes. It was fun. Plus there was this divine dessert that was WOW chocolate lava cake with a hazlenut nutella mousse and espresso ice cream. Okay, I like chocolate, I admit it...It's so nice that my taste buds are working again!! I think the shedding has stopped, which is nice...now if only my eyebrows would start growing again oh and my eyelashes, too. Oh well, it's never a dull moment. I just crack up at myself sometimes becuase I look like a cross between and army recrruit and a concentration camp victim (Okay I guess it's not funny but sad enoguh that it is funny). However, with the wig and a little bit of makeup most people don't even know. Oh well. As I drove to physical therapy and back it felt so great to sing in the car. I haven't been bursting out intosong seeing that I'm at my aunt and uncle's house, so car rides are good for that at the moment. I just love singing to Jesus. I mean, I do that in my heart on my walks, but it's not the same as singing out loud. I miss it and I look forward to being at home so that I can return to doing that in private as well as serving in public in that way.I went to the physical therapist again today and we were able to work together for a bit longer and it really helped. She also worked on my left side which I ddin't realize was as bungled up as it was. I have much greater range of motion on that side, but I'm doing a lot of compensating, too. I know it will take awhile for everything to bounce back, I'm just grateful for what I do have and know that I have to be persistent and sensitive to it.The weather is nice here and I'm enjoying the days left with my aunt and uncle. Thanks so much to everyone who sent cards and letters of encouragement. I really appreciate it!! Julie

newest update

Today I was pretty energetic when I got up so I extended my walk to about an hour and a half. I also managed to work in some lunges and work on my arms during that time. However, the most wonderful part about these daily walks is time to pray for people and time to be open to God speaking to me. I mean, no matter what is going on in our lives we can be so occupied as to be "busy" whether it's my situation or someone who is working daily with a family, etc. Cultivating that time with God can be challenging in the hurly burly of things (okay not my situation at the moment) but those times of connecting with Christ can be so sweet. Ijust loved being able to intercede for friends and family on my walks. God will often bring scripture to mind as well. I think more than anything, God has shown me in this time to just look at everything as a gift. If I'm able to participate in something, I don't have any ownership of it becuase it all belongs to God, all leaders are put in their position by God for His purposes and if I have any opportunity to serve then it is a gift that I am able to do so. I really do look forward to being able to come back and serve in worship and be with the church family again. I was also thinking this morning how we become so incensed when we see someone mistreated by someone in authority or someone who "ought to know better." but God is gracious and has been incredibly gracious with us for our shortcomings and lack of patience or gentleness, and we ought to - instead of looking at the spec in the eye of that other person - look at the log that is impairing our own view of things, namely the sober view of ourselves. God deals so graciously and is so forgiving of us that we need to allow God to be gracious and forgiving with those we feel misuse their power or position, or just blow it no matter whether it is secular or within the church. I was just reminded of how great God's grace is to me and how kind He is and how amazing it is that He holds all things together simultaneously, syngergistically for His credit and His glory. We serve not because we want anything for ourselves, but so that God can be glorified. That's it. Otherwise, our motives are messed up. "Not that we are competent in ourselves to claim anything for ourselves, but our competence comes from God." 2 Cor 3:5 Our value is made plain when God is glorified in our lives, that's when we have the sense that He is active and real and is who He says He is. Anyway, I have really been touched by this during my walk so I pass it on to you all for what it's worth.As for how I'm doing, I'm getting stronger each day but still end up napping at some point during the day. This morning I made a long list of things to do and only did about three of them. I'm still trying to do laundry, but I have to take a nap after I send this to Debbi because I'm tired. However, tonight, my uncle is out at a meeting so my aunt and I are going to go out to dinner. It will be an "outing" and I'm pretty excited about this. I've been getting into watching the Lakers and the Clippers because they're fans of both teams and I must admit I enjoy watching the games as well.So, that's all for now. Look forward to seeing everyone next weekend.Julie

Today's update...

Here's today's update....The weather is just gorgeous here and it's really nice to go out and take my "walkabout" as my uncle refers to it and then begin in on my exercises. I may actually be getting some sun, which would be nice rather than being so pale...Driving miss Julie...Last night, we got in the car to see how I would do shifting since my right side is the one that is bothersome at times and, even though I could feel my muscles working, it wasn't a bad thing necessarily. I was surprised that it was actually work to drive and that my muscles had to work for it. We usually just don't think about it, and frankly neither did I until then. We took a spin around the block and I did okay shifting and turning the wheel, etc. and then down the street to a cul-de-sac and some three point turns. I felt like I was 15 and 1/2 again driving again getting my driving lessons with my parents. It was funny but my uncle was right about just trying to do it in increments rather than just thinking I would get in the car next week and it would be fine. Anyway, he gave me the clearance to take a small jaunt up to the store or physical therapy about one trip per day but not a lot. I need to work up to being able to drive back next week, so if we do it in increments, that should be good.
Physical therapy... Speaking of incremental improvements, I was able to see a physical therapist today that just happened to be right up Fair Oaks Ave, which was great. Of course, I could have gone to USC but this was closer. I've never had physical therapy before, but wow, was it great! She worked on my neck and shoulder on the right side and then spent some time on the soft tissue to help it stretch out as well. It's amazing just how the truncating of the lymph vessels really impairs movement and is a combination of tightness and pain, and also affects the tissues and muscles around it. I realize just how the muscles and tissues are so interdependent. As I right this my pec is kind of cramping up but I'm not stressing about it because of the progress that I was able to make this afternoon with the therapist's help. It was pretty amazing how far I was able to reach after she worked on me. The main problem is that my shoulder is kind of stuck and the pec tensing up doesn't help the shoulder to be free to move. Anyway, I was there for about an hour and a half (paperwork, etc) and I was so jazzed when I was finished becuase I really felt so much better. Even though I had been doing the exercises I was supposed to, there are just some things I can't do myself and I needed help to get some of the kinks worked out. I'll continue to go back this Friday, next Monday and then possibly next Wednesday and then leave to come home to the desert right after that. I was planning to head back to the desert after my next fill next Tuesday but I really like the physical therapist here and I think it would be worth it to stay one more day so that I could get worked on again. Of course I'll need to find someone in the desert who can work on me as well.I was able to drive to the store on the way home from therapy and pick up a couple of things for my aunt, which was nice to feel like I was contributing to the household and gave me a sense of freedom as well. I need to get my car washed so I'll try that tomorrow or Friday.I still came home and crashed out for a nap in the afternoon and I keep trying to analyze why I still need them but, duh, I'm still recovering from surgery and chemo...so I guess I shouldn't be so hard on myself.Oh I'm just so excited about my physical therapy session today, it was just so encouraging that perhaps I'm on the upswing. Yay!God is good!Julie

Well, today was my first "fill-up" at the plastic surgeon's office. I took it easy this morning and only walked for about 20 minutes or so and then really concentrated on my arm exercises. I think my right side is beginning to loosen up a bit, but I'd like to see a physical therapist. I'll start seeing one here before I head back to the desert, but if anyone has the name of someone that they really like who may have worked with mastectomy patients, please let me know :-). Okay, so I had no idea if it was going to hurt or not because some people told me that they had expereicned some pain and others said it was no big deal. Anyway, it's really kind of cool because they use a magnet to locate the site of the place to insert the syringe and then they hook up some saline and start injecting it slow-ly. He filled up about 120cc on both sides and it wasn't uncomfortable. The only thing I felt really was the poke of the needle on the right side going in and I didn't feel it at all on the left. Then, I could feel the pressure of the expanders being filled and pressing against my chest muscles, but it's really not painful, it's just noticeable that there is pressure there. I told him about the fact that I was peeling and he also attributed it to the chemo possibly. What's funny is that the peeling is pretty much just my upper body. Weird, but it seems like it's almost over. I mentioned that my right pectoralis muscle was cramping a bit and Hillary (the pa- who is great) wrote me a prescription for physical therapy. There is a therapist here in Pasadena, I just have to figure out how to get there or see if my uncle thinks that I'm ready to drive...we'll see what he says. Anyway, after the injection was finished on both sides, there was some bleeding so they put some band-aids on and I was out of there in about 1/2 hour after arriving. Pretty quick, though my right side was still a bit bloody when I got home but it's dried up now. After the appointment with Dr. Sherman, my uncle and I went to my aunt's business in downtown LA for a visit (she's a designer) and it was great to see her space and some of the things that she was working on as well as some of the pieces that they were trying to clear out. It was fun to be back downtown again. I used to work at Robinson's corporate downtown on Grand street and it brought back a lot of memories just to be down there. It was a great experience to be on the buying end of things for a few years. Okay, back to the present, I had no nap today but I'm probably going to snooze for a little bit but not much so I can sleep tonight, but I'm so jazzed about the Dr. appointment today. Both Dr. Sherman and Hillary said that they were really amazed at how well my incisions were healing and how little bruising I had incurred - which, of course is all due to everyone praying I just know it. The expanders are also positioned well and they're very happy with my progress. I'll go back weekly to see him until I'm expanded around 400 cc or so and then I'll have a separate surgery to swap out the expander for an implant. That will be sometime in mid-end January.Anyway, I'm pretty stoked becuase everything went so well today and I was able to have a little outing after my Dr. appointment. I'm just so excited that I had the energy to do that after the appointment because I usually crash in the afternoon but I didn't :-).So, all in all a great day and I'm grateful for it.Blessings to all of you and thank you for your prayers!! Julie

Nov. 6 update

Julie's most recent response: "Today was a good day but I am peeling. Yes, peeling. I'm not a snake, really I'm not, but I'm peeling. I know it's weird but my skin is just doing that. Maybe it's related to the fact that my last chemo was about a month ago so maybe things are "re-booting" so-to-speak. Anyway, it's really funny. I've never known humans to shed their skin like this. Guess I'm the first...I wonder if anyone else has been through this experience and if it's chemo related..hmmm. Anyway, with some good exfoliant and lavender oil from Trader Joe's and I'm helping the process along....I went for a long brisk walk today and did my arm exercises as well as some lunges. Yesterday I didn't walk, but rested and I didn't do my arm exercises. That was not such a great idea. I mean, I should have just done the arm exercises at least, because today I took a step back in the flexibility department on my right side. In addition, it seems like my pectoralis muscle on the right is cramping up because I'm feeling regular tightness in my chest on that side, but not on the other. It's kind of a strange feeling because a lot of the tissues are numb, but I can still feel the muscle tensing up and I have to work on it to get it to release. I also wonder if that is common, too. I'll see Dr. Sherman tomorrow for my first "fill-up" and I'll ask about it then. After my walk I totally crashed in the afternoon, which surprised me because I was feeling great in the morning and wasn't even tired on my walkabout. Oh well, I guess I need to step it back - again. I'm so stubborn or competitive with myself I guess that's what I have to work on most of all...The weather is warm here and the day was pretty spectacular. I think I'm actually getting a little bit of color perhaps from being outside and walking daily (yes, I'm using sunscreen in my moisturizer) but it's nice to see that I'm getting some color to sort of belie my army recruit look...I'll let you know how it goes at Dr. Sherman's tomorrow...Love, Julie"
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Today's update...

An update from Julie herself...a real blessing to see progress with each day of health and healing! Julie responds: "Today I took it really easy on the walkabout and did a couple of errands with my uncle and then crashed for about two hours in the late afternoon. I was feeling really energetic before that, however, so that's good. I'm continuing to stretch everything and try to work it all out slowly, which is happening. One funny thing is that my hair is growing back now and there are some pieces on the back of my neck that are kind of longer, so I'm going to have to get them buzzed when I get back. It's kind of funny. Also, I discovered in the shower today that I have an incision deep in my right armpit - gee no wonder it's hard to stretch that shoulder and arm out - duh. As of today I'm bandage and drug free (antibiotics course is finished) so that's great. My aunt and ucnel are preparing a great dinner (I can smell it right now) and the weather today has been beautiful. I'm just so grateful for each day of progress." Julie, thanks for the updates...it helps us to see the power of prayer!

In a recent email, Julie responded: "Well, as for the update, today is better. I still have a slight cough and a little congestion but it's becoming less, that's really great. I went to the doctor this morning and they didn't think that the fluid collecting underneath the drain was that bad. I mean, they were a little concerned but it wasn't that big of a deal. I was actually able to reduce the size of it a bit yesterday by milking the drains more regularly and then kind of manipulating some of the fluid into the drain. That was before the walk...Anyway today's visit with Dr. Sherman and his team was good. They took the drains out on both sides, removed the steri-stips from all of the incisions and said I was looking good. Now, of course when I look at it, I'm not sure that I agree (what do I know, I mean they've done this a ton of times), but I certainly trust them and it was encouraging news. Because the drains are gone I'm "free" of the tubing that I had to carry around so that's nice and they cleared me to begin doing some of the rehabilitative exercises I need to do twice daily to regain range of motion and flexibility in my shoulder, arms and chest. That part is really kind of surprising becuase I didn't realize how much the surgery would really impact me in that regard. I mean, my right shoulder is really stiff and limited and I have to stretch it several times daily, but I know that it will get better. I'm makind a more concerted effort to sit up and stand up straight when I can, too. I did go for a walk this afternoon - after I had taken a nap - and it was not brisk. I just wanted to get outside for a few moments while the clouds cleared. It was cold today and I prettymuch walked around the house with a blanket for awhile and made tea. It was nice. I've been doing quite a bit of reading, and that has been nice, too, but I have to get up regularly to walk around or at least stand up and stretch my neck and shoulders.God is so good to me. I'm so glad that I'm making progress, and even though it seems slower than what I have on my timetable, God knows exactly what He's doing and I'm so glad. I was thinking of the proverb ch 3:3-5 "trust in the Lord with all your heart and lean not on your own understanding. In all your ways acknowledge HIm and He will make your paths straight." I was thinking how when we acknowledge His working in all of our circumstances, good or bad, or trying, or effortless, He makes the paths straight. It's just that habit of being connected to HIm unceasingly (i.e. pray without ceasing) and what a fragrance it must be to Christ that we chose to trust him when we don't feel like it, and the amazing thing is even in the midst of the act of trusting him, Jesus gives us hope in that moment to trust HIm with all of our heart, and to know that He will make our paths straight. I'm so grateful to Christ for his blessings and for you and for all of those who have supported me incredibly on this journey. In some ways, this is the toughest time but I remember that it is all temporary and that HIs grace is new every morning. Blessings, Julie"