This little piggie

I am part pig.

When I was diagnosed with cancer and opted (fortuitously) for mastectomy with reconstruction instead of wire-guided lumpectomy my consultant used adermal cellular matrix (ADM) to make a pocket for the silicon implant. ADM is specially prepared pig intestine and in the UK it’s expensive, so much so that the Chief Executive of the healthcare trust had to approve my consultant’s plea, prise open the NHS coffers and sign a purchase order for another few thousand pounds worth of cancer treatment on top of some equally expensive Herceptin.

I feel hugely grateful that my consultant went above and beyond to get the right materials for reconstruction, and that she’s so skilled and up to date with plastic/microsurgery techniques. She is truly amazing in all senses of the word. At another level I remain somewhat conflicted because an intelligent and sensitive creature gave up its life so that mine might one day return to something approximating normal. That creature – a specially bred pig – didn’t get the ‘tick here to opt out’ box and as a result part of it is now very much a part of me.

On Monday I returned for my annual follow-up and “what next” discussion. Cosmetically there is plenty of tidying up that could be done but I’m not bothered about aesthetics. For me what next has always been removal of the other, “good,” breast before it starts wreaking a trail of destruction through my life. I know too many women whose “good” breast went “bad” after being assured contralateral breast cancer is very unusual. It’s nowhere near as unusual as they or I would wish. For my consultant the original priority was to get rid of the active cancer and start systemic treatment. High grade HER2+ tumours have a propensity to spread and on balance I conceded that dealing with active cancer was our joint priority; we’d return to other potential sources of untimely death later on, when my life wasn’t so readily at stake.

Later on happened to be Monday when we went back through the roll call of women in my family who’ve died of breast cancer at 50 or younger. The list is depressing, more cataclysmic disaster than family tree and although I’m now well versed in talking about it from an emotionally safe distance it retains an ability to trigger unwelcome thoughts and pitiful images. Things I’d rather not recall.

Multiple generations – 8 or more women – wiped out by breast cancer leaves the current generation (me) increasingly convinced that highly predictable trends seldom stem from random coincidence. I am and always have been in a very high risk group. Two decades attempting to convince various GP’s something is amiss in my version of the human genome and finally my consultant declared point blank that she too is absolutely convinced. Coincidences on this scale are not coincidental – her words, not mine. Whilst she’s optimistic science will unravel the faults in my DNA within the next 5 years she’s mindful that 5 years waiting for another high risk (highly predictable?) cancer event to materialise is unacceptable. We’ll be going to theatre again, the fourth time together, just as soon as a slot for surgery comes up. We’ll also be calling on another of our porcine friends so silicon implant no. 2 has a suitable pocket to rest in.

Once this surgery is complete I’ll definitely be ‘this little piggie,’ more pig and plastic than human female. The thought is both comforting and disconcerting.

I stand facing another major surgery which is not without consequences. There’s a chance untoward change is already happening in there (we have to cross that particular bridge if we come to it). There’s a chance things might go wrong – infection, haemorrhaging, skin death. Even if all goes well the surgery doesn’t come with an ‘opt out of breast cancer forever’ guarantee, it reduces risk, not the same as removing risk entirely. Ideally no other animal would have to lay down its life for me but it seems that’s an unavoidable part of this cancer dance too. I guess one way or another the unlucky pig would’ve ended up consumed by humans. At least this way it won’t be turned into sausages…

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12 thoughts on “This little piggie

  1. I am proud of all you have endured and yet you still keep a positive outlook! I am grateful to the piggies and I pray that the next surgery will go flawlessly and that you will heal quickly! ♥ Sending you hugs and lots of healing love always. It isn’t easy to go through all this, I know that for sure.

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  2. I wish I had a double mastectomy. I know research says it doesn’t make a difference but it would relieve my mind a bit. It’s nice though that you are deciding what to do and not “having” to have the operation.

    Hugs from me to you as you think, think and think some more!

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  3. dear Tracy,

    upon reading about your family history with breast cancer on Knot’s site, I can most certainly understand the rationale you have spoken of in this post. i can just imagine how validated you felt when your consultant positively agreed that thinking in terms of “coincidences” as to the sheer number of deaths your family has suffered with metastatic breast cancer is not within the realm of reality. i am just so very sorry that you had to wait for over 20 years to have someone agree with you.

    that you have a doctor with whom you could discuss and agree about priorities with your initial treatment puts you in a place of trust and confidence for this next surgery, and i am so glad for you to have that to fall back on.

    it’s just so like you to express such gratitude for the sacrifices given by two heroic pigs. that really made me smile…i am sending you all my best juju, and holding you up into the highest light of hope for all to be well with the surgery. and can you FEEL the warm hugs i am sending?

    much love to you, dear Friend,

    Karen XOXOXO

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    • Dear Karen, I don’t really have the words to describe how loved and supported you make me feel. To be so kind and thoughtful when your own life has been turned upside down in so many ways makes you very, very special. Angels walk among us and I’m certain you’re one of them because the hug I can feel is so very warm and uplifting. Sending much love to you dear friend, xoxox

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  4. While I am skeptical of many forms of modern medicine. Just healthy skepticism, mind you. Whenever I hear of a new “breakthrough” I tend to read the full story and almost always discover that this was a report of a single test and, to boot, a report that smacks of a false positive. Take the Zamboni treatment for example–a great big fuss, loads of hope and hype but ultimately…nothing. The treatment has no effect. Nonetheless I am happy to concede that we have made significant real strides in many areas–public sanitation, inoculation, trauma surgery and, yes, in many forms of cancer treatment. While it’s been a terrible, uphill climb there is some comfort in the fact tat you are part of a grand march toward ultimate victory. Yes, like all marches the going is, on an individual basis, tough, uncertain. For the group as a whole, though, victory is assured and you get to share in that.

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    • Ultimate victory. Yes, I think so, I certainly hope so. Science is making progress, still painfully slow but that’s what happens when we fight wars with each other instead of fighting war on disease. Not just cancer but Alzheimer’s, cystic fibrosis, Parkinson’s and the rest. In reality any ‘break through’ might come too late for me. Once genes and pathways and proteins start going wrong the end result is a lottery. Some you win, some you don’t. I still aim to beat the family curse but don’t want to set myself up for planet-sized disappointment. I was never any good at long term planning! Whatever happens for me though it won’t be too late for others so if donating various bits of my tissue, blood and family history helps just one other person that makes it all worthwhile.

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  5. I do think there are genetic aberrations which haven’t been discovered yet. I also have a strong history of breast cancer on my mom’s side, but I am not positive for BRCA. I wish you the best of luck with your surgery. You’re a very strong woman; I know you’ll come through with flying colors, even if they are piggy pink:)

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    • It’s funny how we become strong isn’t it. I suppose we don’t get much choice. I’m sorry you have this thing in your family, there are no words to explain the thoughts it creates. I never believed it was a coincidence and after 20 years feel somewhat vindicated. I hope this insight helps you too, especially in a world where we seem to get told if we all avoid alcohol, run marathons and live on broccoli cancer won’t happen…

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  6. Your story, with the HER2 aspect always sobers me (although I’m a pretty sober, NOT happy-go-lucky type of Curmudgeon). While I am the youngest woman in my family with some BC on the maternal side, I always, think, well there has to be a first one in any family. I at times wish I’d had the prophylactic double mastectomy rather than simple lumpectomy, in spite of all the discussion out there saying it doesn’t really save any more lives.

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    • HER2 never really leaves my mind. I remember my consultant saying our conversation would’ve been very different had it not been for Herceptin. I chose mastectomy because my family history was so bad. When they did it there was a heap of other stuff going on throughout the breast and I was told the changes were all likely to become cancer in c.5 – 10 years. My consultant was more relieved than I was having thought the tumour was just 2cm! I don’t know how I knew mastectomy was the only course of action – maybe raw instinct, maybe some subconscious reflection on all my other family members who’ve walked this path, maybe blind fear after reading nothing hopeful about HER2. (I’ve found much more positive information since). From what the consultant told me, my situation was very unusual. I’m sure they’d go back to recommending mastectomy as the first line treatment for everyone if it wasn’t. I guess those things we get quoted – like mastectomy doesn’t save any more lives – are true in the broadest sense because at that level it’s a game of averages. I’d have to look at it the other way round though. As an outlier it still might not save my life but it certainly saved me from developing another raging tumour in the same breast a few years down the line.

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