Thursday, September 13, 2012

EXCHANGE RATE

Have you ever walked yourself into surgery? As in, walked with your own two feet from the pre-op area (where they strap the pic line onto the back of your hand) into the OR? Neither had I. 

The hospital where I had my exchange surgery last week is "trying something new." Instead of being wheeled in on a gurney, I had the pleasure of walking (with a nurse) in my faded gown and anything-but-sassy, mustard-yellow, hospital-issued socks down an icy corridor — straight into the operating room. 


Once inside, they untied my gown and asked me to climb onto the surgical table. I was pleasantly surprised — it felt so soft, like a pillow-top mattress covered in warm flannel. (Turns out they just got new table pads. Score one for me.) As for the "trying something new," I reckon that just means less gurney guys in the wee small hours of the hospital morning.

Prior to my stroll into the OR, while waiting for the day to commence with my husband, we spoke to the very pleasant anesthesiologist about my vomiting tendencies. She assured us she would minimize the chance of this happening.

And so, after 19 long months, I finally, finally have the final surgery to remove my tissue expanders and replace them with permanent implants...
My plastic surgeon, Dr. C., did a lot of "pocket work" on both chest cavities, removing built-up scar tissue and refining and preparing the areas for the implants. They were then slipped under my chest muscle and secured with an array of stitches.

Given my trouble with healing over the past year and a half, Dr. C. also places AlloDerm, a biological matrix, between my right implant and my chest muscle to enhance circulation. (He used AlloDerm during my BMX too.) He cuts through my old incision scars, though only 2 1/2 inches on either side, in the area closest to my underarms.

After the three-hour surgery, when I come to, I don't know where I am. I seem to have forgotten that I was even in the hospital. But then it hits. (Pass the plastic pink bin, please.) Thankfully I had a dedicated nurse for the three hours I was in recovery — she was very gentle and kind and never left my side.

My husband spoke to Dr. C. after surgery was completed, and was told all went well, so while I was in recovery, Husband went to the cafeteria for an early lunch and ran into the anesthesiologist. So he asked how things went. She tells him I am experiencing some nausea. (Yeah, an understatement.)

Two hours later, he is finally allowed in to see me. I remember him walking towards me; I recognized him but couldn't focus my eyes — he was just a big blur. He took one look at me and said to the nurse, "OH. I've seen this look before." Meaning he knew how nauseous I was. He hung with me for another hour, after which my tummy was sort of under control. A short while later, I was in a wheelchair heading for the front door, heading home.

To be honest, I was expecting to "feel" differently when I awoke from this surgery. Trading in tortoise shell-like tissue expanders for soft, round implants seems like a no-brainer; the majority of women I have been in contact with who have been through reconstruction talk up the softness factor they experience immediately upon exchange. (In the inner circle of breast cancer patients, the procedure is referred to as "exchange to squishies.") 

But I feel no such relief. Quite the opposite; I have a lot of pain (mostly on the left side, where Dr. C. did more pocket work) and still feel a tightness overall. I'm bandaged and zipped tight into a compression vest. There ain't nothin' soft about any of this. 

I also have two surgical drains, which I hate! These are my 7th and 8th drains (not that anyone but me is counting). I knew I would have one, and possibly two. They hurt like the dickens, must be emptied twice a day (very gross) and I have to track how many cc's they excrete. My husband was kind enough to handle emptying my first four drains post-mastectomy (mainly because it hurt too much for me to reach around to do it), but since then, I have handled it on my own. 

Having drains reminds me of going through my mastectomy all over again. It's a very raw place to be. 

All these months of waiting while being lopsided, one-sided, and everything inbetween, and I am surprisingly uninterested in how "they" came out. I know from talking to other women that how they look now will differ vastly from how they end up; everything is swollen and misshapen at the moment. I don't want to be disappointed. Best not to get an image stuck in my head. So I don't even bother to look.

I am, however, quite curious as to what size implant Dr. C. ended up using. 

For the uninitiated, it is impossible to determine exactly what "bra size" you will end up being after reconstruction. You cannot go into this process thinking you'll end up being a 36B or C or whatever. It doesn't work that way. Because all the breast tissue is removed during a mastectomy, and the chest cavity is left somewhat deformed, the size of the implant is selected based not just on what the patient wants, but on what her body can handle (inside and outside). In my case, given my skin integrity issues on my right side, we were limited; Dr. C brought six different implant sizes into the OR. 

Fortunately I had instructed my husband to be sure he received the card with my implant info on it after surgery. I was surprised to read that lefty got a 500cc, and righty a 450cc. Hmmm. I'm confused. Since more tissue was taken from my right (cancer) side, so it would seem that there would be more room for a bigger implant, but due to my skin issues Dr. C. couldn't push the envelope. So righty got the smaller implant; lefty, which always had good skin, got the larger. This should be interesting, how I end up looking!

The stinging pain I feel after surgery overshadows any feelings regarding the fact that this long-awaited surgery has finally come to pass. I don't know about you, but my emotions don't work that quickly. I don't immediately go to a "happy" place. I am ever cautious. I was like this pre-BC, but post BC I am even more so. 

A day after I am home, I am taking Vicodin every 4 hours to calm the pain and decide to take a peek. I look down the top of my surgical vest and things appear the same as when I had my tissue expanders. Righty is more swollen. But I'm not fretting. I'm not really focused on them. I really just want to heal and deal. 

I'm sleeping on an incline pillow with pillows on top of that; this is to discourage swelling and assist the body in getting rid of excess fluid. I also have to sleep flat on my back so that my implants stay where Dr. C. put them. (If you sleep on your side or stomach, you can dislodge the implant.) I am a side sleeper, so this incline not only hurts my back but prevents me from getting more than three hours of sleep a night. 

The evening of the day after surgery, I develop a low-grade fever, which decided to present itself after the Vicodin wore off. In addition to being sore, I now feel hot and achy. I'm looking for a break here.

I decide it's time to take a real look. I unzip my surgical vest and am disturbed to see that my dressings are not in place! The big, puffy gauze pads have slipped off the surgical tape that is covering my incisions. No harm done, but good thing I decided to check things out. I tell myself not to be alarmed by anything I see, that my chest will continue to change as the days, weeks and months go on. 

I don't look much larger than I was with the tissue expanders. I'm not sure if this is good or bad. I grab my camera and start taking pictures.

A variety of people are calling the house to see how I am; my husband hands me the phone each time, even when I'm eating or taking a nap. I eventually break him of this habit, but for awhile I am talking to people and pretending that everything is OK (because that's what my husband tells them and I guess from his vantage point, things are OK: I survived!). People just want to know that you are OK. Even though surgery went well, I feel like hell. Do I say that? Well, sometimes I do. But when I do, I'm then faced with folks trying to cheer me up. I don't want to put on the "happy face." I stop accepting calls.

Several friends who have had augmentation surgeries in the past share with me the pain they remember feeling post-surgery in an attempt to connect with what I'm going through. Make no mistake: This is not augmentation surgery. There is nothing pretty about what I have had done to me over the course of 19 months. I feel mutilated. And all I really want is to be able to wear regular clothes again.

So I find myself in a precarious emotional position. Yes, my (hopefully) last big surgery is behind me and am grateful that all went according to plan. But I can't relax. Not yet. Because I know I'm not out of the woods.

Two days ago, I saw Dr. C. and had my drains removed (I have eight drains over the course of this recon, and eight really IS enough!) The good news: I no longer feel like an invalid! But later that day, with my body now absorbing the excess fluid I am producing in response to my surgery, I hear a swishing sound in my right side. It's fluid moving around my implant. My low-grade temperature returns.

I take pictures of myself (something I am doing every other day to document my progress) and email them to Dr. C. I know to look for redness, which can indicate infection (or, God forbid, implant rejection — it is a foreign object, after all) but so far I just have the fever. Dr. C. said a low-grade temp is normal, that the buildup of fluid and the swishing is normal, and if I go above 100 to let him know.

Just took my temperature — 99.9.

PS: For more of my story, see "Solo Sojourn."

34 comments:

  1. Hi Renn, I've been worried about you. I am so glad you posted. I will pray that your temperature comes down soon and that you will feel normal.

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    1. Temp came down! YAY! Thanks for thinking of me, Launna!

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  2. Things don't come easy for you - I know the feeling. But at least I didn't have to walk myself into theatre! I had an infection scare and it turned out to be 'red breast syndrome', which is apparently more common with Alloderm (I didn't have Alloderm.)Hopefully your problem is as benign. I hope you feel better soon and begin to enjoy your new chest. x

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    1. Cait, I think my temp was my body reacting to the Alloderm. Things have settled down now! ;-)

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  3. Renn,
    Thanks for sharing so candidly about what this is and isn't. This post stirs up so many feelings and memories for me...I hope you are healing and feeling better with each day. I'm thinking of you my friend. Take care.

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    1. Nancy, I feel a great need to be brutally honest about this recon process. There is so much suppression that goes on with a cancer diagnosis (I mean, who in our real lives *really* wants to hear all the dirty laundry?) that this blog is my way of getting it out. I know you know what I mean!

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  4. Renn,

    I am woefully behind on everything and I had NO idea you had your exchange surgery. Thinking of you now as the pain begins to subside and sending good thoughts your way. We can talk about walking into the OR another time. I've been doing that since my very first surgical procedure at MSK in 2006. You made me laugh.... "save on the gurneys" .....

    Love you....

    AnneMarie

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    1. AM: Well I don't feel so odd now, I had no idea walking into the OR was so trendy! LOL!

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  5. Renn
    Reading about your surgery reminded me of how many surgeries I had for my reconstruction. People have no idea how complicated breast surgery is from breast cancer especially when dealing with reconstruction. I had eight full surgical procedures and one of my big problems was because I had a radiated breast. The public thinks we are getiing great boob jobs, nd hs no idea that loing brest tissue makes our breasts go numb and there is o much more with the drains and the expanders as well as the implabts. I like you also have issues with nauseau and I aleways have a firm talk with the anasthesiologist about that. There is no reason which today's meds that you should hve oken up vomiting. Luckily this is behind you and I hope everything goes smooth from here and your low grade fever stays where it is and does not go higher. Rest, relax and I hope you have a great cometic result...you have been through so much.

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    1. Susan, you're so right, people don't know. (Heck, we didn't know even as we were going through it!) That's why it helps me to blog about it. I'm sorry you had such a difficult time and hope you, too, are on the other side of it! Thanks for stopping by.

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  6. Oh, Renn! It's never simple, is it? I hate that you have to endure so much, but love how honestly and eloquently you write about it all. Surely that's good therapy. Fingers crossed for speedy recovery.

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    1. Pink: Nope, simple is not my middle name, unfortunately. But writing sure is good therapy! Thank goodness we have this medium, right? xo

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  7. Hello friend.

    I am so sorry that you've been in pain with a slight fever. I am glad to hear that the surgery went well though - I hope your recovery will go just as smoothly and you don't have the issues you had last time.

    I'm keeping you in my thoughts and I hope you a speedy recovery.

    XOXOX

    Carrie

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    1. Carrie! You are always so thoughtful. Thank you!

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  8. Hi Renn, I've been checking every day to see if you've posted and was getting nervous. Your experience sounds similar to mine. I did not wake up "happy" with squishies! But our implants are the same ccs! When all settles, i hope you will be happy with the size. :-) Hmm, maybe not happy since we are numb, but satisfied!i I am so sorry for the vomiting and fever. Let's just get this month behind you, as you begn to heal and pull out of this difficult time. Thanks for the blow by blow, you make me laugh with your wonderful way with words. But did the bucket have to be pink? Figures! Best, Lindsey

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    1. Lindsey, you definitely know how I am feeling! Interesting that we have the same size implants.

      I hear ya on getting this month behind me. I am feeling SO much better this weekend!
      Slow and steady, slow and steady...

      As always, thanks for checking in! xoxo

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  9. Renn ~ There are so many thoughts, feelings, emotions that roil to the surface in reading your account. When you are healed there are so many things I crave to share. For now, know I wish you a healing time. One bit of advice, listen to your own body, carefully. And do not underestimate the resiliance of the never endings in your chest wall pockets.

    With warm thoughts.

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    1. TC, I look forward to hearing your thoughts! And thank you for the reminder to listen to my body very carefully. I can't hear that enough! ;-)

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  10. Hi Renn. So good to 'hear' your voice again - but I'm very sorry to hear about your fever. Hoping like mad that everything settles down quickly. Please keep us posted. I know just what you mean about how post-mastectomy reconstruction is very, very different from a cosmetic 'boob job' (something few of my friends seemed to get -I've had to explain this pretty bluntly at times!). My 'squishy' doesn't have much 'squish', I must say - mind you, it was already in when I had radiotherapy, which would have effected the squish factor!! Sending a cyberhug from down under...

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    1. Hi Liz, you understand completely! I could write a whole post on the frustration in explaining what the heck I've just gone through. (In fact I think I will.) Always nice to hear from you!

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  11. Renn, just checking in on your fever.
    ((((((((((((((O)))))))))))) Lindsey

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  12. Hope you're doing well today. Thanks for the brutal honesty in your posts and not being afraid to tell it like it is.
    ~D.

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    1. Thanks Dee. I sugar-coat enough in my life, I save the extreme honesty for my blog! ;-)

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  13. Hi Renn,
    Well, all I can say is that I can relate. I can't believe how long your process took,and I'm sure hoping you're starting to feel better (seems like you're doing better from your later postings). Reconstruction SUCKS. There's nothing good about it. Hang in there and just let yourself be as mad as you want to. Thinking of you,
    Claudia

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    1. Claudia, I am feeling better. Reconstruction is aptly named, isn't it? You said it best: It sucks! Thanks for stopping by.

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  14. Renn - I'm so behind here... I'm trying my best to keep up. Temp down still right?

    Okay, sorry I have not done a better job of staying in touch. (bad monkey, bad monkey)

    where to begin...

    as far as walking into the operating room.....back, about 7 years or so ago, I had day surgery at Stamford, CT. (unrelated to cancer). Stamford is next to Greenwich but my doctor said he preferred Stamford. No hospital is perfect but I later found out that the wait list was longer at Greenwich, which is why I was at Stamford (understandably so). I was in a big room with several other day surgery people. We were separated only by curtains. When it was my time to go they had me walk, down the hallway, into the elevator, TO THE BASEMENT, and into the operating room. I then climbed onto the operating table and put my feet (dirty skid proof socks and all) in the stirrups. I semi woke up during surgery, saw a man, not my doctor doing the surgery. I also developed an infection. NOT FUN, NOT HAPPY.

    Flash forward to cancer related surgeries. My first was at Memorial Sloan Kettering. They had me walk in. I didn't want to do it but I was so scared I did it. I made them take off my socks. My second surgery was back in Stamford. They updated the facility. They wanted me to walk in. I refused. Eventually they put me in a wheelchair and wheeled me in. They didn't want to do it I had to fake being dizzy. Had another surgery there again, faked being dizzy, made them wheel me in. My next surgery was in Greenwich. Lovely room, they took me via the bed in my waiting room. Very civilized, very relaxing but ooooops, they scratched my cornea during surgery and then ignored my complaints of "my eye hurts."

    As you know, I'm going back in tomorrow and I'm a wreck. This will be my 5th surgery in less than 7 months. I'm worried I'm going to die on the table from too many surgeries and too many disappointments. I'm going to a new facility associated with Greenwich Hospital. They want their money up front and I told them NO. they get nothing from me personally if I die.

    Monkeys advice to pre op instructions:

    I too get nauseous but I'm guessing its not as sever as yours. When I tell them this I add the words projectile vomiting. They give me plenty of anti nausea medz plus a bandaid looking thing behind my ear.

    Tell them you have a family history and personal history of waking up during surgery - make them monitor you closely.

    DO NOT WALK INTO THE OPERATING ROOM. Have them give you clean socks before you go especially if you've visited the bathroom before surgery (and we all do)!!!

    Use the antibacterial soap 3 days before surgery. Do not shave 3 days before surgery. I don't know about the nose stuff but it sounds like a good idea.

    Tell them you had a scratched cornea at your last surgery so they take extra care not to do that again. Sorry if I'm advocating lying but let me tell you that a scratched cornea hurt more than my breasts and it could have easily been prevented.



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    1. OY! I have heard from many people, apparently walking yourself into the OR is NOT unusual! I don't get it. I applaud your gumption to get thyself wheeled in! I hope you do that tomorrow too. (And of course I never considered how gross my socks likely were cause of *course* you head to the loo before you head to surgery!) I just wrote to you on your blog, but let me say here too that I also had a dire fear before my last surgery, which I did not have prior to any of my other surgeries. I too was a wreck. I too had an irrational fear I was going to die on the table. I can only explain it by saying after so many surgeries that do not leave us feeling whole, that it is natural to feel afraid before the one that WILL make us whole again. I don't know if that makes sense now, but I think it will later. Will be thinking of you tomorrow!!! xo

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  15. also... I think I'm getting two different implants, at least that is the plan. My right projects larger so we decided moderate profile on the right and high profile on the left.

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    1. That is common. Though mine were both high profile, they *were* different sizes. We are not naturally even, so it makes sense that during recon we need different things on different sides too! ;-)

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  16. Plastic surgery is very important to us. Today everyone wants to have surgery. Everyone feels good after surgery. You want to look good, then it is necessary to undergo plastic surgery.

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