A FUNGUS AMONG US

We know I am a slow writer. But I'm also a slow healer — something I never knew until my bilateral mastectomy nearly 22 months ago. It's been one long, bloody (in the British sense) battle after another with this right (aka "problem child") boob of mine.

After struggling for months with delayed healing followed by the loss of my right tissue expander followed by the replacement of said expander followed by additional delayed healing, it goes without typing that I was greatly anticipating the surgery to exchange my tissue expanders for permanent implants. (Why do they make "exchange" sound so simple anyway, like going in for an oil change?) Turns out I was more afraid of this "exchange" surgery than any of the others. My butterflies felt more like...
angry birds. Not sure why I was so nervous, since this was the "easier" of my reconstruction surgeries. You know, the first dollop of icing on the recon cake. 

Two and a half months ago, I was finally visited by the "foob fairy" and had my exchange. Then the waiting game began. Since my incision line has always been problematic, I've been holding my breath since September 5th. 

I have been looking forward to getting on with life as I now know it, and the last time I blogged about my life post-surgery, I was back to hiking, and gingerly coddling my new appendages in an effort to enable great healing. But something else has surfaced: I am more emotionally vulnerable and sensitive. I don't have a lot of reserves in the "tough girl" cabinet anymore. Everyone keeps saying how happy I must feel now that this surgery is behind me. What they really mean is how happy they feel now that my surgery is behind them. I get it, I do. Being the supportive friend or family member can often be harder than being the patient. But I can't keep putting on the happy face. I have lost the desire. I also cannot relax because I know I'm not out of the woods. Not the worried-about-cancer woods  — for that forest I will forever reside in — but the healing woods. 

Sept. 27, 2012, my right incision

Here's my problem. Four weeks post-surgery and the surgical tape my plastic surgeon applied is still holding strong. So I can't actually see what is going on beneath these steri-strips. I'm hopeful I'm healing, but I don't really know. 

Being camera obsessed, of course I document each stage. Here is the steri tape starting to lift off. (I know what you're thinking: Could this get any more exciting?)

Then, after so many weeks of holding fast, the tape on my problem child side falls off. And the incision ... dare I say it ... is healing! I keep a lid on my new-found joy because I have been fooled by these sketchy Healing Gods before. And sure enough, as if on cue, I spot the tell-tale sebum spots. Drats. 

October 5th and the healing is fine; October 7th, sebum starts again.

I tamp down the fear that rises when I consider what will happen if this incision doesn't close. I'll be sliding into skin graft territory — and that terrifies me. 

Now my left side, which has never given me an ounce of trouble, decides it's time to join the persnickity party. It holds onto its surgical tape for dear life. For another full week. FINALLY it falls off in the shower and I have all I can do to bring the magnifying mirror closer for an inspection. Hmmm. I didn't see any oozing. No seepage. Nothing yucky under that tape but healing skin and scabs. Blessed tiny scabs. 

But will these, too, fill with sebum? I spent a few days worried about it. Then something miraculous happens. I start to heal. Like, inside and outside heal. For the first time since this %#$@ journey began, I let myself feel the happy. I tip-toe out of the woods and slip into an emotional canyon. Feelings I have been suppressing are bubbling, bubbling. The dam is breaking. I'm a hot, boiling mess. I was warned this would happen by my BC friends who have been through their exchanges. Some of them twice, like my friends named Shannon.

But then Shannon develops cellulitis. Six weeks after her exchange. Are you kidding me? You can be fully healed and still develop a life-threatening infection that requires immediate surgery and hospitalization and IV antibiotics and weeks and weeks of oral antibiotics? When does all this %$@# end? (Oh. Right. It doesn't.) I feel the air leave the room and I wish I could follow it. I am scared out of my mind. Then another friend named Shannon — who has also been through exchange — has to have hers redone (she blogs about it here). Oh the fun never ends.

So I have to figure out a way not to let my anxiety get the better of me. I focus only on the moment at hand. Rest. Eat my protein. Feeling jittery is not going to help my healing. Keep hiking. Writing. Start Christmas shopping. Anything to keep my mind calm and not focused on what could go wrong.

I am OK. I'll be OK. No matter what happens. I know this. So when a new curveball is thrown my way, my mind automatically goes there. And I suspect I'm the only one you know who has experienced what I'm about to tell you.

Rash spreads beyond boundaries of pen mark.

Six and a half weeks post-exchange, I develop a rash on the cleavage side of my right ("problem child") foob. The skin is red, but not warm or sensitive to touch. (Hot, red skin is a classic sign of cellulitis; a fever often is as well. I have neither.) I'm not itchy, though maybe if I had more nerve endings left (guess that's the up side to a BMX). 

Diligent photographer that I am, I dutifully email photos of my lovely rash to my plastic surgeon, Dr. C., who says it does NOT look like cellulitis but he puts me on Keflex as a precaution. Then I take a ballpoint pen and draw a circle around the edge of the rash — that way I'll be able to tell if it's getting bigger or not. 

I wake up the next morning and of course the rash has grown beyond the inky demarkation line. That ain't a good sign. I take my rashy chest to see Dr. C. He says it looks like an allergic reaction. Husband and I can't figure out what I may have come in contact with just on that one side — a true allergic reaction would present itself all over my body — but Dr. C. says my right foob is my body's point of vulnerability. Due to its poor circulation and all. Hmmm. 

I go home feeling unsettled. I put in a call to my oncologist, Dr. D., and manage to snag an appointment a couple of days later. I was actually due to see Dr. D. for my six-month oncology checkup, and I vividly recall the last time I saw him, because as I was leaving his office on that day in March 2012, I received a startling text from my friend Shannon (the very one who developed cellulitis) telling me our online friend, Mary, had passed away. (See my post about Honoring Mary here.) 

Now I'm back at the Cancer Center, and I am flooded by memories of Mary. Dr. D., unaware of my memories, looks and prods and says the same thing as Dr. C: Looks like I have an allergic reaction. Dr. D. is also not concerned. But I am.

So I go home. And I think: Man, I really need to learn how to trust. I mean, two doctors whom I respect are telling me this rash is nothing to worry about. Why do I find it so hard to trust what they are telling me? (This whole breast cancer thing has left me feeling like I have to be Dr. Nancy Drew at all times.) But the point is, when my gut tells me something is wrong, I listen.

 This is how the rash looks when I see Dr. S.

So off I go to see Dr. S., my primary care physician, and I take Husband with me. By now the rash is dancing across my right boob, getting less red in some spots but appearing in round, red splotches in others. It's crazy. Here is what it looked like:

Dr. S. takes one look at my rash and says, "You have ringworm." Huh? RINGWORM? The telltale signs are the round splotches (hence the "ring"). He says he sees a lot of ringworm cases when the seasons change — hot/cold/hot weather causes sweating and we wear heavier clothes so our skin can't breath.

But wait: Isn't ringworm Athletes Foot? Yes, says Dr. S! Apparently ringworm loves moist areas and my hot flashes from the Tamoxifen, coupled with being in a surgical bra for a month and then spandex sports bras after that, makes my vulnerable right foob a target. Turns out the ringworm fungus is in the air all around us and it feeds on dead skin and all it needs to take hold is a moist environment and some old skin cells. I got plenty! Good news: Ringworm doesn't invade the body and is simple to treat. It's not unusual to have ringworm present on the chest; you can get it anywhere on your body. I asked him if I should be showering twice a day, he said NO! Ringworm loves moisture! 

So now I am applying anti-fungal cream 2x daily and taking an oral anti-fungal once a week for a month. I am three weeks into treatment. The rash is getting better, but it isn't gone yet. Ringworm is stubborn.

Nothin' like a little athlete's foot on the boob to put everything in perspective. I was so afraid that I had something more serious! I have never been so relieved to hear that I have athletes foot. Even if it is on my boob! 

A professional bra fitting will have to wait. At this rate, I'll be getting fitted at my two-year cancerversary (the date I had my bilateral mastectomy). If you had told me I'd be in recon hell for two years back then... well, I'm not sure what I would have done.

As for all the emotions that sprung up after this surgery... that's a post for another time. Let's just say the s*** had to hit the fan sooner or later…

POSTSCRIPT: For an update on my rash, please see my "Still Not a Gift" post here.