Tag Archives: medicine

After the sky falls…

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Sooo, after returning to work early-ish following the exchange from skin expanders to implants, I’ve had quite the eventful run of complications. That means I’m sitting here at home again, recovering. Not really feeling inspired to write, but bored to death with feeling bad.

I felt so nearly normal so soon after the implants were placed that I thought I was home free. But one night, I noticed the left breast seemed to be sitting a lot lower than the right. No discomfort, but weird. I got an appointment with the plastic surgeon for the next day, and in the meantime amused myself by writing about Henny Penny and the sky falling, absolutely never suspecting there was a real problem.

OK, so the sky did fall.

While driving myself to Dr. N’s office, the left implant’s pocket started filling with blood & didn’t stop. I could tell something was happening because I felt like I couldn’t breathe on that side. In the rearview mirror I could see a really big bulge over the top of my shirt, near my clavicle. Thank heavens for this fancy hands-free car phone stuff–it let me call home and leave a message for my husband: “Keep your cell phone on–I may need you!”

It’s a blur, but I did get to the office. Dr. N inserted a drain to relieve the pressure and hopefully save the reconstruction on that side. A friend who wasn’t supposed to be at work that day (but heeded the little bird who told her to show up) was available to drive me to the hospital faster than if we’d waited for an ambulance.

After the requisite 8 minutes of chaos, the ER figured out who I was and what to do with me. I was just grateful my friend was willing to stay & hold my hand while I writhed and cursed in and out of consciousness. I cannot adequately describe how it feels when over a liter of blood tries to burst through your skin, so I’ll leave it at that.

I remember thinking they’re just going to let me lay here and die and I’ll never see Brian again. But he’d been called, and soon after the thought, he was there with me, scared to death, too.

All was resolved with a timely return to surgery. Dr. N was suitably impressed by how much blood I’d lost (about 1.5 liters), and happy to have seen the cause of it–one of the little blood vessels that forms during reconstruction was torn & could be seen merrily pumping away. So, that got fixed, a new implant was placed, and I went home the next day with–yes–yet another drain. Not to mention tearful, weak, and pitiful from sudden blood loss.

So relieved to have a husband willing to help with the care and feeding of a PICC line.

So relieved to have a husband willing to help with the care and feeding of a PICC line.

A week goes by uneventfully, tho’ I’m secretly terrified of a repeat. It happened once– who’s to say getting in the shower and washing my hair (as I’d done the morning of my appointment), won’t spring another leak? I’m Catholic. It’s gotta be my fault, right?

So it’s back to Dr. N’s for inspection and to have the drain removed. All seems well until about 5 hours later, when I start feeling achy and warm. That progresses to joints screaming and hot. My temp goes from 101 to 104 within about an hour, and Brian’s making frantic calls to the on-call doc, then Dr. N, then I’m in the car and being carried back to the hospital where I stay for the next few days getting IV antibiotics.

Thank heavens for modern medicine & modern antibiotics. Infection after trauma–surgical or not–is the kind of stuff that killed people when we didn’t have what we’ve got today.

I’m home now getting the antibiotics here, as there’s no oral equivalent of what they need to give me to be sure there won’t be a recurrence. I’ve got what’s called a PICC line–an intravenous catheter that starts in my upper arm and dumps into one of the really big veins near the heart.

So far, each day is a bit better, and I’ve woven for myself an explanatory fiction that makes me less afraid I’ll have another bleed. I can think of the infection as old-fashioned sclerotherapy (therapy that scars) inside that pocket, sealing off any potential little bleeders that might lurk there.

And there’s Dr. N’s assurance that “this never happens.”

Except in one case he had where a woman’s stove electrocuted her.

And me 😉

I’m wounded and can’t get my bra off.

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Anyone tired of pain and angst and wimmen’s stuff can go home right now. But I can’t get off this bus and writing’s a distraction, so I’m gonna stay right here and bore y’all to death.

I’ve taken the muscle relaxers (the ones that cause 6 hour crying jags). And the lorazepam (goody, now I get to wake up feeling like the world’s going to end). I’ve got one NSAID pain patch plastered to my front, another to my back, and my husband nearly broke his thumb trying to push the muscle spasm or rib or whatever it is that hurts like hell back to where it came from.

Ain't it cute? Don't it look nice and soft and squishy? Nawp. They lie. And where's the stud-finder, dammit?

Ain’t it cute? Don’t it look nice and soft and squishy? Nawp. They lie. And where’s the stud-finder, dammit?

So I lie on the “Miracle Ball” for the requisite minutes and then do it again out of sheer desperation. Now I’m sitting against a yogic torture device called a Spoonk that’s advertised as the Western answer to acupuncture. All this because I’ve got what feel like armadillo plates riding against my ribs and the suckers are pulling my back out of joint.

And I still don’t have to do chemo. Yay! That heads up my gratitude list every day of the week. But tonight I’m doing my best imitation of British whinging, just for fun.

Actually, the anatomic explanation above isn’t quite right. I quizzed my plastic surgeon about exactly where these tissue expanders live and learned they aren’t just lying quietly on top of my ribs “under the muscle,” as I so casually assumed. During surgery the pectorals are actually butterflied lengthwise, their points of insertion left intact, and the expanders jimmied between the layers like stuffing in mock duck.

All’s quiet for awhile (or else surgical pain overrides awareness of anything else), but a couple weeks later, when they whip out the stud-finder to start filling the expanders (see previous post), the muscles stretch and spasm. And in my case have pretty much never stopped. I wake in the morning with the equivalent of tennis balls stuck under my skin. That’s if I slept at all overnight. I don’t remember having any dreams at all during these last two months. Once things quiet down I should have quite the cinema line-up for REM sleep.

So maybe the surgeon’s right and I have what he calls “reactive” pectorals (he is a pretty smart guy). You mess with them, they kick back. Like the frogs’ legs my mother once made me watch her cook. I see this fairly often during cesarean section; we’re not anywhere near the pecs, but similar slabs of muscle in the abdomen can do the same thing. It’s usually handling the peritoneal membrane underneath them that causes spasm and vomiting even with adequate anesthesia, but in some folks “just” pulling apart the abdominal muscles produces the same effect.

Trouble is, these suckers are STRONG. There is no denying a pissed off pectoral. Because of where they are, they pull on the ribs and yank those circumferential items slightly off-kilter, causing spasm in other, unforeseen areas. Which has been my problem lately.

This is more like it. The deflated inflater. More like what I just got at Petco--a dog toy with "squeakless technology." Yep, that's what this thing is.

This is more like it. The deflated inflater. More like what I just got at Petco–a dog toy with “squeakless technology.” Yep, that’s what this thing is.

My husband was horrified to find thumb-shaped bruises where he’d been pressing on my back. I assured him I’d not complain to authorities, as this was likely due to my using twice the recommended number of non-steroidal patches (along with a handful of naproxen, if truth be told). This all messes with blood clotting abilities. Whereupon he’s horrified I exceeded the recommended dosage. Whereupon I’m amazed that we’ve been married lo these 23 years and my MO still surprises him.

Now something I forgot to mention is the saving grace of having a physical therapist who really knows her wimmin’s business. Also high on the gratitude list. Every whining complaint I’ve thrown at her has been no surprise. She’s heard it all before. Thank heavens.

Thank heavens I’m not the only one who feels these plastic things getting hot against my chest wall. That the saline ports are hard, and hurt. That tissue I’m told has been denervated may be numb-ish to the touch on the outside, but has plenty of sensation pushing through from the inside.

But hey, Dr. Susan Love says says most women don’t even finish their pain meds. Must be true, right? She’s written a fat book about everything breast. If Marcus Welby, Dr. Quinn, and Hawkeye Pierce joined her for a focus group and came to the same conclusion, well, maybe I’d suspend disbelief. We’ll just not consult Dr. House.

Thank heavens the therapist knew to insist I request a reduction in the bigness of these things before I had more trouble with an already compromised right hand (that would be from the heartbreak of thoracic outlet syndrome, which is a wastebasket diagnosis and doesn’t really exist, as we all know). As soon as they let a little–a measly 2 ounces–of fluid out of the right breast my hand stopped its neurogenic tingling, my breasts regained just the eensiest bit of squishiness, and I felt like a new person. This is what I’m told will happen when the expanders are exchanged for “real” implants. We’ll stick with the smaller size, thanks very much.

But now the pecs have caught on and decided to take up the slack. Hence the new muscle spasms and this new-ish rant of mine. Bear with me and I’ll apologize (again) next I see you.

What follows is something not for the faint of heart: placement of the expander within the muscle.

I really don’t want to freak anyone out, but can’t seem to post the link without opening the graphics.

It’s my party and I’ll cry if I want to…

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So I spent the last two days trying to take a friend’s advice. “Quit feeling sorry for yourself and write something interesting.” He was a little more tactful than that, but I got the message.

I did try, honest. He even gave me a good jumping-off point: my original mission statement for the Situational Midwifery blog–a soapbox about things encountered as a midwife. The things that piss me off about women’s health care. About how nothing has changed much under the sun. How women and their problems are often blamed for, well, women and their problems.

I’ve got half a lifetime’s worth of subject matter, but right now that’s not not exactly what’s rising to the top. Go ahead and look forward to future harangues, but for now they’ll be about my own stuff.

Participation is optional. Nobody is required to read a blog. I haven’t been a professional writer for more than half a lifetime now, so for all I know, it’s crap. Or it’s crap to men, or it’s crap to folks who haven’t faced something similar. I’m ashamed to say I’m one of those. I got so tired of my mother’s crying jags and worries and photos of grotesque surgeries that I was nowhere near as sympathetic as I might have been. At 15 years old. So I understand that point of view, too.

So read on, or not. Part of what I’m learning these days is to stand up for myself. My friend has given me yet another opportunity to do so, even though I’m afraid he’ll take this the wrong way. If I never hear from him again my husband (who loves this guy), will be really pissed. Then I’ve got two problems.

Sh*t.

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I hate having meltdowns. So I had two on Sunday. Sort of because my neck was killing me and Tylenol doesn’t cut it. And the chiropractor wasn’t in (lazy sod).  Retaliated by eating three ice cream bars. That helped. Then I got proactive and watched “Mastectomy and You”–the DVD my surgeon assigned. Like I get brownie points for  writing a book report. Or returning it on time. Like the stupid thing’s gonna help.

Should have been more protective of my mushy mind. Choose one source of information and stick to it, I say to my patients. Do I take my own advice? Noooo. The DVD pics bear little resemblance to the ones the plastic surgeon showed me. Not that they’re so bad, they’re just not so good, either. Hence the meltdown.

I swore I wouldn’t cry. Years ago Mom cried enough for both of us, wasting months wailing about which lifesaving procedure would, in fact, save her life. That she had months to waste should have been a clue. Her diagnosis was DCIS–now considered a high-risk precursor, but not cancer itself. Eligible for lumpectomy. In the 70s they didn’t know that and didn’t seriously offer anything other than modified or radical mastectomy. Didn’t offer reconstruction, much, either. If they did, it wasn’t until years after treatment, once survival was pretty much guaranteed. The fear was that reconstructed tissue and thick scarring might make a deep recurrence nearly impossible to see. Misogyny and concern rolled into a tight little bundle. And utterly believable as far as my mom was concerned. Lop off her breasts and replace them with something that could moot the whole point? No thanks.

Lord knows things have changed, and I’m grateful for it. Scoop out the offending bits and deal with the rest later. Unseen recurrence? Not likely. Leave the hospital with something that hurts, but pokes out instead of in? Priceless.

Mom and I were different in lots of ways. I guess every one of us is. After seeing those godawful mastectomy scars every day after my 15th year, the decision was made loooong before I was ever diagnosed. My best friend got leukemia. Possibly an infinitely worse diagnosis than mine. Ended up with stem cells, a stroke and a bald head. She rocked that look. Mom and her concave chest? Not so much. My aunt (her younger sister) didn’t even want to try it. Diagnosed two different times, she was stuck with two different reconstructions because silicone wasn’t on offer the first time. Her words to me? “Just do it.” No matter what the technique, just do it.

And her advice, I’ll take.

Hot diggity!

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Wow. I didn’t expect to be giddy with relief after the surgeon’s appointment today. Like Cinderella at the ball. Or Dorothy home in Kansas.

The three page birth plan is back in force. There will likely be no chemo. And probably no radiation. My hair won’t fall out and my skin won’t peel off. I won’t feel like I’m dying in the midst of “treatment.” Nobody batted an eye at my request for skin-sparing bilateral simple mastectomies and immediate reconstruction (the first steps of it, anyhow). The incisions are small, and the procedures will be done by folks I trust. All my externals will be left as they are–maybe even with some sensation. My friend Michelle just messaged me about the “awesome new rack” I’ll get for my troubles. LOL. I’ll be happy with just short of normal.

All the arcane testing done on my cells says they haven’t gone nearly as awry as “invasive” breast cancer implies. Chemo won’t work on “non-HER-2 expressors.” Or those with a “low Ki-67 proliferative rate.” Am I the only living woman with an urge to thank an under-acheiving cancer mutation? Mom viewed my decision to become a nurse as evidence of mediocrity. Well, hoo-yah!

We shall see. The above changes if it turns out some pesky cancer snuck into my lymph nodes. That will be determined with surgery and could require radiation. But by then I’ll have the expanders-soon-to-be-implants (yay silicone), and there’ll be no going back.

…I got to reading that last sentence, and realize there are friends and patients I know who’ve had a terrible time with aggressive cancers and all the misery chemo implies, as well as postoperative complications that require going back to the beginning and starting all over again. In the face of all that, my giddiness may well feel selfish and downright insensitive. I apologize. I’m enjoying the moment, though, and trust you don’t begrudge me that.

Late night thoughts…

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Lewis Thomas had his, prompted by Mahler’s 9th Symphony. And I’ve got mine, though none so lofty. Mine are like: Geez–nobody looked up Amazon (previous post). Everybody’s so freaked by the damned disease that they’re going to go through life thinking Amazon mostly means

  • an online bookstore
  • a river in South America
  • a big green parrot in South America
  • mythical female warriors who lopped off a breast the better to draw a bow

Actually, if you remembered the last one from 8th grade history, you’re close to being right. Amazon translates “without breasts” from the Greek. I only know this because I’m freaked by the damned disease too, and that piece of trivia came up early in my internet wanderings. I have no idea why it seems important tonight.

My dear friend took me to lunch yesterday. She’s so emotionally intelligent, anyone lucky enough to be her patient is really lucky. She asks things like, “what do you want to have happen?” and “what scares you?” Like she’s not afraid to hear the answers. Like if I don’t know, maybe she’s got some ideas. Or maybe not. But that’s ok, because at least she thought to ask the questions.

On the other hand, I already told folks at the office that I’m not into the whole “cancer journey” thing.

“So how’s YOUR journey going?”

My darling dad, a very private man, was mortified when an enthusiastic greeter at a center for alternative medicine grasped his hands and insisted on defining this “journey” for him. He was supposed to emerge changed: “different, yet somehow better” than before cancer. Actually, he was dying. He knew it, and he hated it. As was his right. As is mine, should it come to that.

And nobody’s shaving any heads. I’ve been put on notice by my friend Pam that she’s sure as hell not gonna be bald just because I get that way. I still have a niggling hope that I won’t be. My dad used a cold cap during chemo infusions, though his oncologist scoffed. But he kept his hair. A friend who was a cancer nurse introduced the idea, said she’d seen great success with it among patients at Cedars Sinai. Well, I’m wildly enthusiastic about the possibility of keeping some hair, even if the evidence-based-medicine Grinch won’t support it.

Oh.

Please.

There will be no talk of making plaster casts. None whatsoever. Pregnant bellies are fine in this medium. Old boobs are not.