Surgery Rescheduled, and Other News

It’s been a relatively low-drama but high-stress time in our house. I’m slowly recovering from the chemotherapy, with accent on the slowly. I spent the last few weeks waiting for the results of my genetic test panel, prepping (mostly mentally) for surgery, reading about recovery, preparing my advance health care directive, and avoiding calls, emails and visits.

Yes, let me be honest: everyone wants news and I had none yet, and everyone has questions that I’m too frazzled to hear. So I kept a low profile; I apologize to my family and friends, I know they only ask because they care and I do the same when our positions are reversed. Consider this part of my self-care (my blood pressure results and disrupted sleep patterns confirm that I’ve been stressed.) However, yesterday brought some news.

Gene Genie

The genetic test panel was negative for mutation of the two genes most commonly associated with breast and ovarian cancer, BRC1 and BRC2. However, it did return positive on one of the two copies of gene MRE11A, recently linked to ovarian and breast cancer — so recently that numerical risk factors are not yet available. The genetic counsellor is going to do some additional research on the latest info and some modelling, and will call me back later today or tomorrow.

At this point, if no quantified risk factors are available and barring contrary advice from my medical team, I would go ahead with the current plan (conservative breast surgery and radiation therapy), with the recommended increased cancer screening in the future (I understand this means alternating every six months between MRI and mammogram.)

Cut Scene

I also had some blood tests done yesterday morning. Most important result: my blood coagulation rate was still too slow for surgery. As a result, my operation has been postponed to Friday next week, September 30. Since there are a bunch of pre- and post-op checks associated with it, I had a flurry of phone calls, messages, and reschedulings yesterday afternoon and this morning.

In fact, this flurry really did not help my stress situation: while I was on the phone with one department, another would call and leave me an urgent message! Add a few calls from family and friends in the mix, and me eyeing the clock for returning calls; and unrelated technical difficulties with various electronic devices in the house. By 7pm, I was ridiculously frazzled. And part of it, of course, is that I would have liked to be done ASAP with the whole surgery mess.

Not Much Thicker Than Water After All?

Getting back to that coagulation rate: I had an INR of 4.0, if you care for numbers, which means coagulating four times slower than normal. I’ve been on warfarin for three months to prevent the recurrence of blood clots. A few days before the surgery the patient stops taking warfarin and instead takes Lovenox injections. However, not only was my coagulation rte too slow yesterday, but it was the slowest it’s ever been, slower than it should even be in optimal warfarin use (the patient’s dose gets adjusted to maintain an INR of 2.0 to 3.0.)

The Anti-coagulation Clinic pharmacist doesn’t want to ramp me back up on warfarin before the surgery, so she had me take two days off from all anticoagulants, and I’ll have another blood test tomorrow morning to see if I should get back to Lovenox injections yet. After the surgery, there will definitely be some dosage adjustments.

I also received other blood test results in the evening. It looks like my white blood cell count and platelet count are inching up, but all the indicators relating to red blood cells don’t seem to have improved in five weeks. I hope to discuss this with a doctor today or tomorrow.

In Conclusion…

Things are not awful or miserable, they’re just proceeding with some inconveniences and, mostly, leaving both Edmund and I feeling anxious.

 

 

 

 

Masks: Play report and review

A few weeks ago, our friend AW ran a one-off episode of the role-playing game Masks for me, my husband Edmund, and two more friends, SP and MP. I thought this was a good time to talk about this game since the PDF version just became available on DriveThruRPG. First, I share a play report that goes a bit long, but talks about the mechanics as well as the fiction generated in play. I follow with a review of the game.

A little walk for my health

As I recover strength after chemotherapy and in preparation for surgery, I need to exercise a little. My medical team has recommended that I walk at least ten minutes a day, something that is laughably short when one is in good health but tiring for me right now.

A doe leaping to flee.

This afternoon we went to walk along San Andreas Lake near our home. I walked a total of about twenty minutes (slowly) then spent some time sitting under a tree, admiring the view while Edmund was taking more of a “real” walk. Butterflies and dragonflies were flitting among wildflowers, and I saw a good deal of wildlife.

The deer seem to have a neighbourhood association rule: only one doe and her fawns at a time. The first doe I saw was standing guard while her two fawns played; suddenly I saw her raise her head and alertly look around, then I heard her call a challenge a few times. Then she leaped around and bounded to collect her fawns and flee.

A moment later, another doe with a single fawn emerged from the opposite direction and came to claim what appeared to be a choice spot. Then they too eventually left when yet another family showed up.

Overhead I saw a red-tail hawk lazily gliding in circles on the thermals, looking for prey. Later on Edmund pointed out a couple of bald eagles fishing and performing aerobatics near the lake surface, soon followed by the unavoidable turkey vultures hoping to get a free meal.

I was tired when I came back and had an hour’s nap.

Night Witches: Wrap-up and Mini-Review

Yesterday we brought our Night Witches campaign to a close, as the war ended in Europe with Germany’s surrender. Here is a quick look back at the campaign, followed by my review of the game itself.

Campaign Highlights

• Amazingly, four of the seven original characters made it out alive (Maryam, Elena, Vera, and Oksana, played by Edmund, Steve, Alan, and Sophie.) For a while now Elena had been close to taking her last mark — “Embrace death and find your final destiny” — so we were all trying to keep her from meeting the bad premonitions she’d been having!
• Of the others, two players had to drop so their characters (Yulia and Valentina, played by Christine and April) were technically still alive.
• One new character (Anya, played by Adi) had appeared after the earlier tragic death of an airwoman (Sveta, also played by Adi).

Most of us took a turn at being game-master for one duty station or another, which gave us a chance to learn GMing tricks from each other. I really liked that, and I know I will use some of these techniques with other games.

The most marking events in the campaign, the dramatic fulcrum, were Elena forced by circumstances to kill a German prisoner to save him from a worse fate, followed by Sveta abandoning hope and dying in a subsequent mission. We had tragic loves, stormy friendships, splendid bravery, and wistful secrets.

We all stamped our mark on the squadron: Maryam was our fearless leader, fiercely protective of her airwomen; Elena was the career communist, slowly losing both faith and ambition; Vera was the cheerful pragmatist who always had a trick up her sleeve; Yulia was the sweet young recruit painfully hardened by war; Sveta was the tough-minded survivor who lost her zest for life after one too many tragedies; Oksana was the secret romantic who always tried to have her sisters’ backs; Valentina was the wild rebel; and Anya was the gutsy late-addition to the squadron, trying to make her place without being pushed around.

Mini-Review: Night Witches

The role-playing game Night Witches was written by Jason Morningstar and released by Bully Pulpit Games in January 2015 after a successful Kickstarter funding campaign ($48,806 pledged, well surpassing the $5,000 goal.) The game is Powered by the Apocalypse.

The Good

Night Witches brings its own refinements to the basic structure introduced by Apocalypse World. For example, the general moves are divided between those taking place during the day and largely involving caring for the regiment, your own squadron, the airwomen and the planes; and moves used during the night missions to accomplish mission objectives and survive encounters with the enemy. Several day moves allow the players, if they so wish, to accumulate “mission points” which can be used one-for-one to add to rolls on night moves.

These general moves are well designed to daisy-chain and create story material. Combined with the handouts supplied by the publisher for duty stations, missions, Witch-y things that can happen, period history, lists of names, etc., these make the GM’s game preparation very easy. No need to plan for complex story arcs, just sow some seeds and the story will happen. Like all PbtA games, it does require that everyone be willing and able to improvise in response to other players’ choices and any triggered moves.

The setting is fantastic, of course. The game’s focus on the experiences of women in one of the most brutal theatres of this exceedingly brutal war is new, refreshing, and challenges a lot of role-playing tropes. The fact that it is also historical, documented, real makes it resonate all the more. If you want to expand from the useful notes on the period provided in the book and handouts, there is a wealth of material available (free or inexpensive), including patriotic music and amazing Soviet and German maps of the era.

Finally, I also got the optional card deck that supplements the book with character portraits, play aids for flight missions, medals, and quick-start character background elements. As I’ve said before, I’m a sucker for visual aids and this one combines art by Claudia Cangini (portraits) and Rich Longmore (plane schematics) with vintage Soviet playing card deck backs!

The Bad

Like most other PbtA games, Night Witches‘ character creation process centres around playbooks, essentially templates with a menu of options each character can choose from. There are only five playbooks or “Natures” to pick from: Owl, Raven, Hawk, Pigeon, and Sparrow. You are encouraged to include as many as you can in the game, but you can have more than one player using the same Nature. You can never go back and change a character’s Nature, however. Each has its own special moves.

After picking your Nature, you choose one of six Roles (Adventurer, Misanthrope, Leader, Zealot, Dreamer, and Protector) which will also give you access to a special move. Roles can change throughout a character’s life.

Unfortunately, the Natures did not feel intuitive for anyone in our group and the special moves granted by Natures and Roles were not as fitting as they might have been.Most of us ended up picking very few advancements from the special moves available to use, preferring to get promotions, improve stats, or forge and change bonds. I believe every character still in play at the end had used their one opportunity to go get a special move from a different playbook, reinforcing the sense we got that playbooks did not hang together in a satisfying way.

In some other PbtA games, such as Monsterhearts, Dungeon World, Monster of the Week, or Masks, the playbooks correspond to easily-grasped archetypes and the special moves fit well with them so that you have little trouble figuring out “what my character would do.” Then again, the game that started it all, Apocalypse World, contains playbooks and associated moves that I found difficult to understand (e.g., the Battle Babe that doesn’t actually, y’know, battle), so as they say: your mileage may vary. Nevertheless, if there is ever a second editions I would recommend revising the Natures, Roles, and associated moves.

Overall Assessment

This is a memorable game that has produced intense episodes in our campaign as well as in one-off convention games. I have never had a boring session. It’s easy enough for a GM to pick up and run, provided you familiarize yourself with the PbtA style. (For example, a GM has to realize that she never needs to roll dice in these games — the players do all the dice rolling.) Five of us took our turn at the helm during the campaign, including two that had never game-mastered a PbtA game, and everybody did a bang-up job.

This is not the kind of game book that provides extensive setting material (for example, most GURPS sourcebooks); it offers well thought-out summaries and sketches, just enough for the reader to understand the situation without getting mired in detail. (Naturally, our group of geeks immediately turned to historical sources and went down the rabbit hole of research!) For my style of GMing, the amount of material was just right.

Yes, there are wrinkles around the playbooks, but they are not show-stoppers. Perhaps fan-made playbooks will appear and add the finishing touch to this already amazing game.

Mouse Guard Must-Have

I’m very late in discovering this, but the hardback compilation Mouse Guard: The Black Axe is a must-have for all readers of the Mouse Guard comics (David Petersen, published by Archaia) and especially for players of the role-playing game based on the comic, the Mouse Guard RPG (Luke Crane & David Petersen).

It’s full of information about what the Guard Mice do, the art is as inspiring as ever, and the book offers a nice appendix full of maps, illustrations of locations, genealogies of famous mouse clans, etc. (You can see examples of location art here, but the ones in the book are different and contain much more information.)

Maps, Guides and Assorted Extras

1108: Map of the Mouse Territories

Farrer genealogy

Navigation aids

Port Sumac

Day 18, Cycle 7: Pivot to surgery

Last infusion: finished!

Having received my last chemotherapy session, I’m now being allowed to rest and recover for the next phase. Although I will still receive Herceptin intravenously every three weeks until late March 2017, I’m done with the strong, destructive components (Carboplatin and Taxotere) that kill cells.

I’ve been marvelling at how precisely the dosages are calculated to take the patient exactly to the point where they can tolerate that last infusion but not one more. You really feel like you could not get up anymore if you had another round.

My skin still shows the last two rounds’ worth of skin burn despite the careful flushing of the IV between medications and after. At Day 13 they looked like this (they’re a bit better now):

Left: the most recent, inside the right forearm; centre, the sixth infusion,  back and wrist of right hand; right: an example of the butterfly needle used.

The Oncatogy team

I have felt very tired since the infusion and have not recovered my appetite, but my taste buds are gradually returning to normal. (Thank the Flying Spaghetti Monster!) I have spent most of my time receiving felinotherapy with the Oncatogy Department.

When I’m awake I’ve been researching the surgical options, namely conservative breast surgery (a.k.a. lumpectomy) and mastectomy. Most resources say that out comes at 10 and 15 years are similar in terms of survival and recurrence, so choice should really be based on how important it is for the patient to keep her breast and/or to have symmetrical breasts.

While that’s correct as far as it goes, the phrasing always makes me feel frivolous: “Of course, if you really must keep your breasts…” Well, duh. Yeah, I’d like that very much but I don’t want to die early for it either. A little help, here? I tend to decide based on risk factors and quantifiable outcomes when I can.

Finally, some of the recent articles I found were more helpful (links below). Based on them it seems that conservative breast surgery is easier on the patient with fewer complications and possibly slightly better outcomes overall, though with a slightly higher (by four percent) risk of recurrence. The primary differences lie in the need for general anaesthesia for mastectomy (and an overnight stay at the hospital) versus local anaesthesia and sedation for conservative breast surgery (an outpatient procedure), as well as the number of lymph nodes removed (the fewer, the least risk of lymphedema.)

After all my reading, I felt more inclined towards conservative breast surgery unless the genetic test results indicated a predisposition to breast cancer (BRCA1 or BRCA2 mutations.)

But I was tremulous when I met again with the surgeon on Wednesday. She comes across as very focused, rigorous, factual. In our first meeting back in March she had presented the options but like most modern doctors, refused to give advice one way or another. This time I started by telling her what homework I had done and what my current inclination was, and she suddenly had this big smile. “I’m really glad to hear you say that!” she exclaimed.

We went in detail over the compared procedures and follow-up steps, and the various complication risks. Then we tentatively scheduled the conservative breast surgery procedure for September 21, as well as a bunch of the pre-op checks. If my genetic test results come back positive for breast cancer markers, then we’ll reschedule for a mastectomy.

I have to add that Dr. Chen seems to be very popular with the staff. Several people in other departments waxed eloquent about her. This does not happen for just any doctor; it feels out of the ordinary. The anaesthetist’s medical assistant was telling us that she insisted, when her own sister had breast cancer four years ago, that the surgery be performed by Dr. Chen. This too was a conservative breast surgery. (The sister is doing well, apparently.)

And after conservative breast surgery, I’ll be looking at one or two more weeks of recovery, followed by five to seven weeks of radiation therapy, five days a week. That should take us just about to the holidays…

Links

• BRCA1 and BRCA2: Cancer Risk and Genetic Testing. National Cancer Institute, National Institutes of Health (NIH), U.S. Department of Health and Human Services.
• SABCS 2015: Comparing Lumpectomy vs. Mastectomy: Survival, Complications and Cost. Karuna Jaggar, Executive Director, Breast Cancer Action.
• Ten-Year Data: Lumpectomy and Radiotherapy Trump Mastectomy. Nick Mulcahy, Medscape.
• Deciding: lumpectomy vs. mastectomy. Barber and Richardson PC.
• Lumpectomy Versus Mastectomy for Early-Stage Breast Cancer. Emma Shtivelman, PhD, Cancer Commons.