When Laser Met Vagina: the MonaLisa Touch, Part 1

Full disclosure: I received the MonaLisa Touch treatments for free so long as I blogged about it - the good and the bad. Anyone who knows me knows I don't sugarcoat anything; if something sucks, I'll tell you it sucks. That's the brutal honesty of my journalism upbringing. This procedure didn't suck, which is good because it involved a laser and my girly parts. Read on for installment No. 1 and stay tuned for updates about the other two MonaLisa Touch sessions.

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Vaginas and lasers—I used to think those two things went together like "live wires" and "standing in a bucket of water." Do lasers belong in those delicate nether regions? Believe it or not, I'd argue they do.  

Over the course of the past year or so, there’s been some chatter in my online breast cancer Facebook support groups about this very topic. I, along with many other survivors and those called “previvors” (the brave gals who’ve gotten surgery to prevent hereditary cancer) would eagerly grill a group member about her experience with some fantastical device called the MonaLisa Touch. How many treatments does it entail? (3, about six weeks apart) How long did the treatments take? (About five minutes each) Was it painful? (No).

For most of us, the MonaLisa Touch procedure, which isn’t covered by insurance, was cost prohibitive at $500 or more per treatment (based on your physician and where you live), so we wanted every detail, every possible success or drawback before we even considered undergoing it—and we wanted multiple recommendations. Many agreed that even a modest amount of relief from our symptoms would make this worth it.

That’s certainly how I felt.

Menopause magnified

More than three years out from my breast cancer diagnosis at age 36, and more than two years after my hysterectomy/oophorectomy, I was painfully aware of the effects this cancer business and a lack of estrogen had had on my body. All the glorious things that come with menopause, things that take a good 10 years or more to hit most women, I had managed to squeeze into less than two years. At the age of 39, my libido was shot and my lady parts were like the Sahara Desert.  (I swear, I would wipe after peeing and there would be tumbleweed on the toilet paper.) And sex? That was about as pleasant as planting a bare bum on a Bunsen burner.

There are some studies focused on MonaLisaTouch and how it may relieve the painful symptoms of menopause, and many of the women in the Facebook groups had anecdotal tales of success. At the bare minimum, it seemed this laser treatment gave a small measure of relief. On the other end of the spectrum, there were women raving about how they could finally enjoy sex again for the first time in ages. I wanted to know where I’d fall on the spectrum, so I decided to saddle up.

Photo Credit: Rob Young

An approximation of how menopause made me feel, minus the camel

As luck would have it, someone from the breast cancer nonprofit I volunteer with knew someone who could hook me up with a doctor. Treatment would be complementary so long as I’d write about my experience.

To the laser!

Forever the health reporter and cynic, I didn’t have much in the way of high expectations as I jostled my way through the holiday crowds around New York City’s Rockefeller Center on my lunch break for my first of three 5-minute treatments. Couldn’t these people see I was on my way to get my vagina “lasered?” MOVE, people!

When I got to the office building of urogynecologist and author, Dr. Elizabeth Kavaler, I contemplated forgetting the whole thing and opting instead for lunch at New York Yankees Steak next door. But I’m a Mets fan, and I had been through way worse. Time to buck up, buttercup.

Dr. Kavaler went through my rather depressing personal health history—bilateral breast cancer, BRCA2-positive, strong family history of breast cancer, double mastectomy, chemo, tamoxifen, painful intercourse—the whole nine yards. She debriefed me on the finer points of the laser, how the fractional CO₂ power it harnessed was based on the same premise as the laser resurfacing plastic surgeons perform on the face to stimulate collagen production and give skin a more youthful appearance. My vagina was getting a facelift, so to speak.  But this wasn’t about making things look prettier down there.  Rather, I really wanted the treatment to make things function like they did before my cancer diagnosis.

“OK, are you ready?” Dr. Kavaler asked.

“Oh sure,” I said, as if I did this sort of thing every day.

And away I went, whisked off to an unassuming treatment room that housed no terrifying equipment, nothing resembling a blowtorch, which is good because scary equipment probably would have sent me screaming from the office.

A topical numbing agent was applied to the delicate areas and when everything was good and numb, the laser inserted. Slowly, Dr. Kavaler pulled it through the vaginal canal. At one point, I felt a slight pinching sensation that lasted for a split second. That was it. I was done a few minutes later.

Now, I’ve had some women ask me how it felt after treatment. The best way to describe it is, for about two hours after I completed that first treatment I felt like I had ridden many miles on a road bike—you know, those bikes with the really uncomfortable seats. But by that night, my vagina had recovered. I had no discharge or bleeding.

Now for the good stuff …

Of course, by this point you’re thinking, “Yes, Heather, but what about the sexy time?” Those who know me best will tell you, I don’t promote or rave about much.

I waited more than a week after my treatment to have sex with my husband, who, by the way, is pretty much the most patient and understanding man on the planet. I think he was curious about how things would feel post-treatment, maybe wondered if my vagina had some cool new super powers or something.

The first thing I noticed about the first time was that I had lubrication. Not a tremendous amount, but more than before. Prior to my treatment, it didn’t matter how turned on I was. There would be the need for lube. This time around, I still needed some help, but only a little. Which brings me to the next point…

Hallelujah! I had absolutely no pain! And sex actually felt, dare I say, very good. Is it like before I had my treatments and surgery? No. But I think with the second and third treatments, things will only get better, though I don't think things will ever be "the same as before."

Before treatment, I cringed at penetration and in my head I would be working out ways to avoid it. “You sure you want to do this? Whoa, was that an earthquake I just felt? Did someone just ring the doorbell? Hold up! I’m pretty sure I left a roast in the oven. I’d better go check.” Now, I look forward to sex and actually initiate it.

I certainly never thought I’d say this (or would have reason to, for that matter), but my vagina and I can’t wait for our next date with the laser. Stay tuned!

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Blame It on the Chemo --- or How I Came to Sign Up for a 200-Mile Bike Ride

Chemo damaged my brain.

Those who have known me long enough would say, “You mean, ‘Damaged it more?’” Yeah, well, screw you if you’re thinking that! Anyway, it’s true: Chemo has affected the part of my brain responsible for rational decision-making. Exhibit A: I signed up for a 200-mile charity bike ride, despite the fact I haven’t been on a bike in more than 30 years (it was Pepto-Bismol pink and had a green frog on the banana seat), despite the fact I was pretty sure I'd be a slacker when it came to training, and despite the fact that when I registered, I didn’t own a bike. 

Those who have known me long enough would say, “Charity bike ride? What is the charity? You?” Yeah, well, screw you if you’re thinking that!  Anyway, Tour de Pink East Coast benefits a wonderful organization called Young Survival Coalition, which provides education and resources to young women diagnosed with breast cancer, like me. I would never consider doing a ride of this nature unless it benefited a cause very near and dear to my heart, and unless I could ride with a whole bunch of awesome people. I suppose I also did it because I could; 2016 marks the first year since my diagnosis that I haven't had any part of my body removed or worked on. I suppose it also helped that the chemo damaged the part of my brain responsible for recognizing my athletic limitations. 

I was so worried about raising the minimum $2,500 for this ride that I sort of forgot to concentrate on training. Then I focused on securing my team some super awesome custom jerseys and kinda let that consume me. Then I was like, what about accessories? We must have the proper accessories! ...Shhhh! Did you hear that? It's the sound of training falling to the wayside.

I'll get this bike-riding thing down eventually.

Now I find myself 17 days before the ride and probably only having racked up about 40 miles over the course of a few infrequent excursions. Those who have known me long enough would say, “40 miles—really? Didn’t think you had even that in you. Did you accidentally get stuck to the back of someone’s bumper and get dragged?” Yeah, well, screw you if you’re thinking that!  Anyway, my goals for the ride changed: I’ve gone from “I want to complete as many miles as possible” to “Please don’t let me die.” Believe me, the irony of dying during a cancer bike ride isn’t lost on me. But hey, if I face-plant or get hit by a truck full of hot garbage, I’m going to look good when it happens, thanks to a stellar custom jersey and killer accessories.

Luckily, I’m also teamed up with some pretty great gals (and fellow slackers): childhood pal Tara and fellow survivor and “BRCA sister” Mollie. We’re the ride’s equivalent of the kids who sit in the back of the class, passing inappropriate notes back and forth and competing to see whose farts are the loudest. Not coincidentally, at the back of the pack is where we plan to ride (due to lack of training and, more importantly, out of concern for the safety of our fellow riders).

We won’t be the fastest, won’t be the most stable on our bikes and won’t have road rash on anything less than 90 percent of our bodies by the time this is done, but we will be surrounded by amazing (and inspirational) Tour de Pink riders and we'll be having fun. Those who have known me long enough would say, “I never doubted that.”

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Make a tax-deductible, totally secure donation here

I have a thing for nice, round numbers and I’d love for my team to hit the $10,000 mark. If you’re reading this and can identify with slacker underdogs like me and my teammates, please consider making a donation to the cause. Seriously, it can be, like, $5. No amount is too small. And you can keep your donation amount hidden, then go around and brag to everyone about how you donated a king’s ransom. We won’t tell.

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Breaking Up is Hard to Do

Tuesday was my last “date” with my oncologist. 

Ever since I had heard he was leaving to practice in Florida, I had been trying to compile a list of reasons he shouldn’t go. All I had so far was 1. It’s too humid down there and he’ll have to live with frizzy hair and 2. The most insane news stories come out of Florida. Did he really want to be a part of that? (No offense, Florida.)

Dr. Asim Aijaz’s practice has always been insanely busy, something I chalked up to him being an awesome oncologist. Every time I left his office, I felt like my concerns had been heard, and I knew exactly why treatment was proceeding the way it was. I never doubted the path I was taking. Yes, the wait to see him could be interminable, but that’s because he took his time with you. Funny thing, I never heard other patients complain; they knew that they, too, would get his undivided attention when their names were called.

But the typically buzzing office is quiet today. In preparation for his departure, Dr. Aijaz has stopped adding patients to his calendar. My butt never touches a waiting room chair as I’m sent straight into the back office for my blood work. As the nurse is trying to find a functioning vein in my battered circulatory system, I spot the good doctor walking quietly down the hall.

“You! I’m going to have words with you,” I say sternly, pointing a bony finger at him. He pretends to duck into an exam room. “You’re lucky I’m getting my veins prodded right now!” I yell.

Something tells me my oncologist will have no shortage
 of interesting patients in Florida.

After I’m patched up from three attempts to get blood, and I've lied my way out of getting weighed ("I weighed myself not that long ago and here is the weight I wish I was"), I make my way down to the exam room to wait for the doctor. Finally he appears. “You,” I say again and trail off. I had been prepared to chastise him for breaking up with me. How could he do this? I’m young and need many more years of follow-up. I hate change.

He perches himself on the end of the exam table, and I’m reminded of the first time I met him in December 2013. “I know a lot about you,” he had said then, leaning against the exam table. He had studied my chart, my lab results and everything else in my folder, which at that point was the thickness of “The Grapes of Wrath” and about as equally depressing. He knew me, and he knew what course of action we needed to take. He was very methodical in describing why my tumors were ugly, and why chemo would be needed to reduce my risk of recurrence.  

He uses this same methodical manner now, to break up with me. It wasn’t me. It was him.

He carefully explains that he received a great opportunity in an Orlando health system. It's a step up in many ways. As the only oncologist in this New York office, his current workload is insane. He has kids almost the same age as mine. He’d like to spend more time with his young family, and Florida presented the best opportunity for this.

How the hell was I supposed to argue with that reasoning? Me, who wanted nothing more than to spend more time with my family? It was at this moment that I really began to think about the personal lives of those who work tirelessly to fight cancer and extend lives—the missed family dinners and the children's bedtime stories that go unread because patient appointments ran long that day.

Everyone always focuses on how much doctors make, but you know what? You couldn’t pay me enough to be a doctor. Not that I’d have that opportunity anyway. No way could my attention span see me through med school, fellowship training and whatever other hoops they make you jump through before you're allowed to look after humans. But I’m thankful for those people who do make this sacrifice, for putting in years of training to help people like me. (This includes those unsung heroes of cancer care, the oncology nurses, as well.) And kudos to the all the healthcare practitioners who are able to finally achieve a work-home balance.

I ask about what I do now. Do I stick with the practice, and his replacement, or go elsewhere? In his usual honest manner, which always gave me the sense he was looking out for me and not the business side of medicine, he advises me to go elsewhere. Did I mention I hate change? He hands me the contact information for recommended oncologists—my confirmation that I have to start all over again with another doctor.

With that, we exchange “good lucks,” and shake hands.  He’s sad, I can tell. After all, how could he possibly get lucky again and find another patient as endearingly crazy as me? Then I remember where he’s headed and I smile. Where he’s going, he won’t need luck. 

How to Screw Cancer Patients Over Like a BOSS: Tips Gleaned from the Folks at MVP Healthcare

     

How many times have you said this: “Man, I wish there was a quick and easy way to screw over a cancer patient and not pay for services that should be covered!” Well, if you’re an insurance company, you’ve likely uttered this at least 5 million times a day, and you probably have a very precise method for addressing this. But MVP Healthcare may have a better solution!
            MVP is for the first time (unintentionally) revealing its secrets for dicking over cancer patients and aggravating them to the point of insanity, and we think you’ll find it’s very efficient. 

Let’s take a look at how the process works, with one patient we’ll just call Heather, and let’s say she had aggressive breast cancer and is looking for reimbursement for out-of-pocket expenses related to nipple tattooing, a widely recognized final stage of breast reconstruction:

No, not a fan of MVP at this point.

Step 1: Make your company policy known upfront while feigning faux compassion. Example: “Oh Sweetie, I don’t know the specifics of your case, and you haven’t even submitted any paperwork yet, but go ahead and file that claim. They’re not going to pay it.” Cancer patients enjoy being called things like “honey” and “sweetie.” These verbal pats-on-the-head are a sure crowd-pleaser!

Step 2: Don’t bother to say things like, “You needed pre-approval,” because your company’s policy is to deny these claims no matter what the fuck Heather does. This is also the point you ignore all supporting documentation Heather has sent, including a letter of explanation and support from her plastic surgeon and photos of her titties. Holy fuck! Why did this crazy bitch send pictures of her carved-up boobs? Ain’t nobody want to see that shit! Lunch is RUINED!

Step 3: Point out that nipple tattooing by prominent tattoo artists who are known nationally for doing these sorts of things are not covered because they’re not recognized providers. Ignore the fact that hair salon owners are also not recognized providers but insurance companies, including MVP, often cover the cost of the chemo wigs they provide. Roll your eyes if Heather mentions her plastic surgeon doesn’t do tattoos, so she had no other options for completing her reconstruction.

MVP apparently thinks this looks completely normal.
Nope, no tattoos needed here.

Step 4: Speaking of chemo wigs, ignore Heather when she tries to use the example of the time you attempted to deny her coverage for a chemo wig, though her benefits book said you covered 50 percent of the cost, and you tried to deny payment for fat grafting as part of her reconstruction because you viewed it as “cosmetic.” Fuck, don’t these cancer patients ever let ANY shit go?

Step 5: Never give a straight answer. Let’s say Heather calls to check on her claim because she never received anything in the mail acknowledging it but she sees online that it was just denied, with accompanying vague codes mentioning a random code is missing or that she should have only had one nipple done per day. Inform her that, why, you just CAN’T figure out what’s going on and you’re sending her claim back for reprocessing, which should clear things up. Have a good laugh about it when you get off the phone.

Step 6: Play loose with deadlines. Have the first representative tell her that reprocessing her claim should take a couple of weeks, then when that deadline passes, have the next representative tell her that, no, you have 30 days before you have to make a decision. When THAT deadline passes, have a supervisor (let’s call her Sue) tell Heather when she calls back that, “Hey, you were told initially that we weren’t going to pay.” When the patient puts up a fight and mentions what she’s calling a “runaround” (PFFFT! WHATEVER!) tell her you’re on the case and you’ll get back to her with more information on how to proceed. Give her your direct phone line, but –AND THIS IS IMPERATIVE—make sure it’s the wrong number.

I finally feel complete with the tattoos.
But "feeling complete" is not something MVP covers.

Step 7: When Heather calls the next day and points out that the number you gave her directed her to a pre-recorded message, telling her that to go further, she will have to answer some questions and she’ll be entered to win a free cruise, let out a little laugh and make your voice sound apologetic about giving her the wrong number.  Also, make a mental note to bring up with your company’s top brass that you have a great idea for a cancer cruise, which will round up all of the cancer patients and set them adrift on the ocean.

Step 8: Make up more excuses. Something like, “Well, it appears in order to get this claim settled, we have to formally deny it. It was never properly denied.” Heather will mention that there were denial codes attached to her claim and she will ask, “Doesn’t that constitute a formal denial?” This is where you say something super confusing, like, “I would tend to agree with you.” Heather will ask what the fuck that means, but you don’t have to answer. Make it known you’re just the messenger! You should also at this point pretend you still care about Heather’s well-being, and that you want to help her get this claim settled, even though that would mean working against your own company. Maybe she won’t figure it out. 

Step 9: Record a denial of appeal in record time. This will let Heather know how wrong she is—and yeah, go ahead and try to file a level 2 appeal, you dumb shit, Heather. You’ll want to assign a senior medical reviewer for her appeal who is in a totally unrelated field of medicine, say, family practice, and have that person be so fucking dated that he/she could have theoretically been the attending physician at the Battle of Gettysburg. Such a top-notch doctor overrides a practicing plastic surgeon with extensive experience in breast reconstruction and microvascular surgery EVERY TIME.

           

Step 10: If the patient mentions that all stages of reconstruction are covered by the Women’s Health and Cancer Rights Act, stick your fingers in your ears and go, “La la la la – I CAN’T HEAR YOU!”

Just Call Me 'Nip': Virginia Tattoo Parlor is My Breast Reconstruction Finish Line

I'm one of those people who can't make her mind up about anything. Seriously. I will agonize over a restaurant menu like that meal is the friggin' Last Supper. Just fucking pick the wild rice or couscous, Heather.

'Nipple-palooza' was a family affair.

So imagine my anxiety when I find myself seated in Amy Black Tattoo and surrounded by Benjamin Moore-esque pigment samples.  I'd been preparing for this day for months, had conveniently scheduled my nipple tattooing here in Richmond, Va, amid my family's end-of-summer vacation. But somehow I'm still not ready. On the table in front of me are many color choices. Colors that would end up on my breasts. For life. Amy is reiterating that if I'm not sure, I don't have to do this today. The procedures to remove tattooing are costly and time-consuming, she says.

Is this an anxiety attack or hot flash? Beads of sweat are forming on my brow and I may or may not have just tinkled in my pants. (Oh, who the hell am I kidding? I definitely wet my pants. Thanks, hysterectomy.)

Call your husband and get his input, Amy suggests. But he's down the street at the toy store, trying to keep our kids entertained. Her suggestion will involve him dragging our children back -- no small feat -- and you know they'll have their own ideas about the nipples Mommy should get.  No doubt Nora would recommend getting Elmo-shaped headlights, while Fiorello would favor something pirate-themed -- perhaps some spirited Jolly Rogers.

No. Not an option. Right now, the only other member of my family present is my son's hermit crab, Pincher, who came along on our vacation and is sitting calmly in his cage on the floor of the tattoo studio. That son-of-a-bitch is of no help, so I'm on my own.

After much deliberation and some concerned looks from Amy on my indecisiveness, I manage to settle on a color selected from her vast collection of client photos.  She prints out a picture of said nipples, cuts them out, and has me hold them to my chest, trying to gauge my reaction. "That's it, although maybe just a little browner," I say way more confidently than I feel.

Time to get started

I'm fairly certain I won't feel this, given the extent of my DIEP flap procedure -- aka, "the nerve slayer." Heck, you could mistake me for a Holstein and try to milk me, and all I'd feel is some pressure. However, apparently what goes on at the surface is much different than what lies beneath.

Most women don't feel the tattooing. However, I'm not one of them. "Oh yeah, I feel that," I tell Amy as she begins outlining the areolas. She asks me to rate the pain on a scale of 1 to 10, and I place mine somewhere in the area of 6. According to Amy, I'm a rarity who happens to have about 70 to 80 percent of the feeling of someone who hasn't had her boobs chopped off and rebuilt.  Good job, nerves! However, it's nothing that some numbing cream can't take care of.

Getting nipple tattoos is not as orgasmic as I make it look.

Joining me just as the ink starts to flow is my longtime friend from high school, Nicole. Ever the multi-tasker, I managed to find a talented tattoo artist who happens to work out of the same town Nicole now lives in, so I get to see my friend AND get inked. Thankfully, she's not freaked out by the sight of delicate breast tissue getting tattooed and is a willing photographer for this event. (Side note: For the ladies out there considering nipple tattooing, I highly recommend bringing along a friend or someone else close to you for input and support.)

As Amy does her thing, my mind wanders to one of the choices that was easy to make: coming here for this final stage of my reconstruction. A lot of women talk about and opt for "a Vinnie," which is code for tit tats by Vinnie Myers in Maryland. The guy is unbelievably gifted at what he does. But I've seen Amy's name come up in my BRCA groups on Facebook, and for me, something just clicks. She's got a skilled hand and she's launched a nonprofit that helps women pay for post-mastectomy tattooing. I love that. Plus, her studio was recently blessed by some bad-ass Tibetan monks, so I'm feeling pretty confident going into this. It's kind of like my nipples are Dalai Lama-approved or something.

The actual tattooing doesn't take that long, and before I know it, I'm standing in front of a full-length mirror on the wall of the tattoo studio, admiring my new reddish brown nipples. They look way better than the originals, which had transformed into veiny flying saucers following pregnancy and breastfeeding. This was my one opportunity to get the nipples I had always wanted and I ran with it.

That's all, folks!

Whoop! There it is! There's actually a lot of texture and variation
in shading, but my camera sucks so you'll have to use your imagination.

And so came the symbolic end to my breast cancer journey -- at the least the procedural part of it, anyway. On October 2, 2013, I met with my breast surgeon to figure out what the fuck we were going to do about my diseased titties. That had been a Wednesday. By the following Monday, I was meeting with a plastic surgeon to draft a game plan for the painstaking, hourslong surgery required to piece me back together immediately after my double mastectomy.

I had choices in how I wanted to go about certain aspects of treatment - whether I wanted implants or to use my own tissue to recreate the breasts. I was able to choose putting off chemo just long enough to enjoy Christmas that year. But in many ways, I never felt like I had a choice. I did what I had to do. So here I was, finally able to make a choice about the color and texture and shading of my new areolas, and I completely froze up. Guess I was wading into unfamiliar territory. However, I'm beyond thrilled with my nipple results. As I've said before, they're the cherries on top of the mammary sundae. (Bet you'll never look at ice cream the same way again.)

There's still one teensy detail I have to take care of: getting my insurance company to reimburse me the $500 I shelled out. Even though the Women's Health And Cancer Rights Act says, "Hey! Assholes! Cough up the dough for reconstruction," insurance companies still try to find ways out of it.  I'll let you know how I make out. (I'm guessing I'll be using the words "Fucking mother fuckers" a lot.)

The Nipplemorphasis

The night before phase 2 of DIEP flap reconstruction
-- aka, nipple reconstruction and fat grafting.
At this point a wardrobe malfunction for me would mean ...
pretty much nothing. I come self-edited!
(November 2014) 

Sweet holy hell, I look like a calico cat! The bruising is from fat grafting.
This is a few days after phase 2.
(November 2014)

About a week out from phase 2; the nipples were rebuilt
using the "origami technique." Eat your heart out, Martha Stewart!
(November 2014)

Approximately 6 months after phase 2. The one advantage of being
 a pasty Irish mofo is your scars fade nicely.
(May 2015)

Immediately following nipple tattooing. If you stare at them long enough,
they'll start spinning and playing calliope music.
(August 2015)

The final product -- I love my new breasticles!
By a week out from tattooing, I was pretty much all healed.
Anyone know of a local strip club that does
 an "Amateur Stripper/Mastectomy Night?"
(August 2015)