DELAYED HEALING

Alas, I do not have much room in my brain to fully ponder the notion of not going to the Cancer Center for 180 days. Why? Because my beautiful new incision (read about that here) is not healing again. (Warning: There will be pictures involved.)

Trouble starts up again: The telltale yellow spots.

Three small yellow/green spots (not infection, but excess collagen which is interfering with my body's ability to close my skin) develop along my right incision line. I continue to keep it sterile and covered with antibiotic ointment and Xeroform and plenty of gauze (which I have to change every few hours, because the fluid my body is producing is leaking through the spots in my incision. Kind of like having a bad period, but continuously).

I keep Dr. C.’s office informed, and I monitor my progress (or lack thereof) by photographing my incision line each morning. I also rest more by taking a long nap every afternoon.

Can I just say how hard it is to try and lose weight when I have to eat more food rather than less? Dr. C. told me that healing "is not the time to restrict calories." And getting in 100 grams of protein a day — protein promotes healing — means eating every three hours. (See my Top 10 List.) I can’t lift anything using my right arm because the incision is still healing. No pulling, no pushing, no carrying with that arm. No upper body exercise aside from gentle stretching. Walking is fine, as is the elliptical (but no arms).

I still feel semi-exhausted most days. Though I realize I've been under anesthesia twice in the past month (4 ½ hours total), in my mind I feel like I should have more energy. The old me is having a hard time accepting the new me.

Three spots converging to become one.

And I continue to document my progress with my digital camera. I highly suggest this practice.

After several weeks, I notice my revised incision is not healing properly. The yellowish green spots have merged, colliding to become one larger spot. Dr. C. doesn't like the look of it. He wants to "debride" (i.e., clean up) the unhealed area and re-suture my incision line. Again.

I'm pleased he’s taking the precautionary road and we are dealing with this surgically (my other choice: continue to take a "wait and see" approach while continuing to use a special “debriding” ointment, but that doesn't seem to be helping), but I’m not happy about having a 3rd surgery.

Quarter-sized spot

The spot grows to become the size of a quarter (see photo at right). So five and a half weeks after my last incision revision (and 8 weeks after my bilateral mastectomy), I am wheeled for a 3rd time back into the operating room. The staff is familiar to me now. They recognize me. “Oh, I remember you!” (Nothing like being famous in the OR.)

Dr. C. debrides the area and re-sutures the skin. (And yes I'm loosing a little skin each time he does this.) He removes another 50 cc's of saline from the right tissue expander, reducing the pressure further in an attempt to get it to heal.

My right tissue expander is now less than half the size of the left. Yes I am very lopsided and that makes it difficult to disguise in clothes. (As if having coconut shells on my chest weren't enough, mine seep and are different sizes! Oh the joy!) I buy a heavily padded bra that I wear to give the illusion of a normal shape. (Just don’t hug me.) But most days I live in my surgical compression vest — which I still must wear 24/7.

Newly debrided, re-sutured incision

My new incision, however, looks beautiful (see image at right)! I am told to focus on getting back to life: keeping up my protein intake, walking, trying not to do too much around the house (I have to force myself to limit movement of my right arm so I don't put undue pressure on the new stitches). My energy is coming back despite having 5+ hours of anesthesia in two months. I’m back to hiking twice a week.

But as all things in the world of cancer, nothing ever goes as planned. Several weeks pass and again, the tell-tale spots. (What a sinking feeling that is.) The spots are small, and do not advance as quickly as in the past, which is good (and I make note of), but still, it's hard to ignore the fact that this incision does not want to heal. (My other side? Completely fine, still.)

With spots come seepage. It's almost like my incision is weeping along with me. The seepage seems to be tied directly to how active I am. If I work at the computer and then take a nap, it doesn’t leak; if I take a hike, make a salad or drive to the grocery store, it does leak. How much of a prison can I live in? I vacillate between doing nothing for days on end, and trying to be normal (save from using my right arm). And still I leak. Labs show no sign of infection, BTW.

I am a patient woman, more patient than most, but WTF? Seriously, I am so over this. There have to be other women out there who are struggling with these healing issues too. Sure enough, I head online and start a thread within the BC group for tissue expander problems (aka “delayed healing”). Once I connect with others in my situation, I feel far less alone, knowing these ladies "get" the frustration I am wallowing in. Some had infections that prevented their healing; some had allergic reactions; some experienced rejection of the expander (their body viewed it as a foreign object); some had an expander that sprung a leak (it happens!); others had thin skin due to radiation or surgery — the latter of which we believe is the cause for my troubles. My surgeon scrapped as much tissue out of my affected breast as possible during my mastectomy (I told him I didn’t want any tissue left for bad cells to move into so get it out, please — and he did). But now there doesn't seem to be enough circulation in the thin skin that surrounds my incision.

Dime-sized hole in my incision.

Despite the exercise, the protein, the non-use of my arm, the naps and my (generally) sunny disposition, my incision doesn't heal. The main spot widens to the size of a dime. (Better than a quarter! See photo at left.)

Office stitches

I know I can heal this if Dr. C. reinforces the center of the spot — so he gives me a four blue stitches (in his office this time, no anesthesia, and yes I was scared).

I have been wearing my surgical compression vest and changing my gauze dressing for 5 long months. I can do it a little longer.

Husband and I decide to take a short trip to Las Vegas to celebrate our anniversary and take my mind off my healing. It works; I am able to completely forget I have cancer (seriously!) and I feel like the old me. It was fabulous.

Except when it wasn't. We were walking a lot, so, natch, the seepage increased. (We went to a show one night, and I was seeping so much I had to stuff a washcloth in my big bra to safeguard against leakage.)

The "What happens in Vegas, stays in Vegas" addage apparently doesn't hold true for me. I make an appointment with Dr. C. to discuss said seepage. He removes my pretty plastic stitches and says the incision looks great, but is concerned that the incision is not sealed. He explains that because my skin is so thin, any buildup of fluid will exit at my weakest point.

We are bandaging the wound differently for the next few weeks to see if it heals any differently.

Then we start talking about Las Vegas. (Funny, I don't remember telling him I was going.) I say it was great to get away. He asks how we liked the Wynn. What? How does he know we stayed at the Wynn? I look at him, perplexed. He keeps going. “You were on the 60th floor, right?” Whoa. What? "How do you know that?" I ask. He laughs and says he saw my husband and me get on the elevator just as he and his wife were getting off. He called out to us but then the elevator doors closed.
He figured I didn’t recognize him in his pool shorts. (He would be correct; I usually see him in a suit.) I added that had I seen him, though, I would have told him I had a washcloth stuffed in my bra! We had a good laugh.

When I tell Husband the story, he laughs too, then has a vague recollection of a guy in a straw hat, waving at us from an elevator. Small world, isn't it?

HOUSTON, WE HAVE A PROBLEM

I'm at a follow-up with my plastic surgeon, Dr. C. Unfortunately, he's not 100 percent happy (his words) with the way my right incision is healing. He used the term "delayed healing." It's worse on the right (cancer side) than the left. My skin is red on that side and looks bruised. I have surgical tape on both incisions, but beneath the tape a dark area is visible. Dr. C. cautions me to pay close attention to this area, because if it gets any darker, that means my skin is dying.

Necrosis? Oh, joy.

I'm to use Xeroform as a wound dressing. But first I apply Bactroban (an Rx antibiotic ointment), which I then top with a strip of Xeroform, which I then top with gauze which I then tape to my skin. I’m to continue to wear my compression vest 24/7. (Confession: It’s become a rather comforting contraption.) And if my incision doesn't decide to heal, Dr. C. will decide whether to surgically reduce the pressure in the tissue expander by removing some saline. Super duper!

And as if all that weren’t enough, Dr. C. is leaving the country in four days — for three weeks. Yikes.

I get home from the doctor, pull out my digital camera and start shooting close-up images of my incisions. I do this each morning. Husband finds it odd. I tell him it’s the only way we can be objective; from day to day things look fine, but if you compare Day 1 to Day 3, well, you can see a difference. (Note to all surgery patients: Photograph your healing journey.)

A few days go by. After my shower one morning, I inspect the wound. I don’t like the look of it. More redness, more darkness at the incision line (under the surgical tape). I take more pictures.

My dear friend M. comes over for lunch. But I'm in a bad mood — definitely not like me when I am spending time with friends — and I can’t seem to shake it. M. asks why I’m feeling unsettled, then encourages me to call my doctor. It’s 1 PM on a Friday afternoon. What are the chances I’m going to reach anyone? But lo and behold, Dr. C.’s nurse answers the phone, and I lay my worry out there like a blanket on a fire. But she is not alarmed. The redness I'm experiencing sounds normal, she says. She’ll mention to Dr. C. — who happens to still be in the office. Psyche.

I hang up and feel good that I’ve taken action. Yet something is still nagging at me. Finally, a light bulb goes off: Email Dr. C. a few photos so he can see exactly what I’m talking about! (This also saves me a trip to his office, not that I could get in on a Friday. Just sayin'.) I call the nurse back and tell her to check the JPegs I just emailed. If I don’t hear back from her today, she says, that means Dr. C. thinks things look fine and I should keep up with the Xeroform program until he returns from overseas.

OK! Now I can finally relax. I enjoy the rest of my lunch with M. and she leaves in the late afternoon.  No call from Dr. C.  I take a nice, long nap, then rummage through the refrigerator for something to eat.

While I am downstairs, my cell phone rings upstairs. I don't hear it. By the time I realize I have a message, it's 7:30 PM.

Guess who. Yup.

Dr. C. apologizes for messing up my weekend, but he wants me to meet him at the hospital tomorrow morning — yes, Saturday morning — at 5 AM. He has secured a surgical room for what he is calling a “minor intervention surgery.”

I don’t have time to think, to worry, to even wrap my head around the fact that I am about to have another surgery just 16 days after my bilateral mastectomy. (Cancer: The gift that keeps on giving.)

Husband and I go to bed early, get up at 3:45 AM and drive to the hospital in the dark. I’m prepped and wheeled into surgery by 7:30 AM. Luckily my anesthesiologist hand-tailors an Rx cocktail (along with a patch behind my ear) so that when I came to, I am alert and not dizzy or nauseous, and am able to go home 90 minutes later. (So not like last time.) I am also not in any pain.

Turns out too much pressure on my tissue expander was causing my skin not to heal. I have necrosis on the top of my incision, but there is also a spot that is necrotic under the skin as well — and that is the dangerous part. If we don't fix it now, I run the risk of losing the expander and starting over again. So Dr. C. removes 50 cc's from my right expander (originally filled to 400 cc's), debrides my wound and re-sutures my skin.

I feel like I dodged a big, necrotic bullet, and am proud of myself for staying on top of this, for diligently taking photos of myself, for coming up with the idea to email them to the nurse, and for trusting my gut throughout. This surgery wouldn’t have happened otherwise. (Listen to your instincts, my friends, even if it means calling your physician on a Friday afternoon and having surgery on a Saturday.)

The following day, just 30 hours post-surgery, I show up at a party to meet our neighbor’s first grandson. People are surprised, even shocked, to see me; they tell me how great I look, that they can't believe I just had another surgery. Me either. Even though I am light-headed and have very low energy, it still feels good to get out among the living. I even forget about my pressurized chest for a couple of hours.

The next few days are hazy. I feel woozy, but we manage to take in a matinee. (Again, a sense of normalcy I desperately need.) And yes I'm still watching these incisions like a hawk. Snapping pictures every day, oh yeah. And applying my ever-trusty Bactroban and Xeroform.

But my smile belies how I'm really feeling: blah, depressed, unfocused. What does going through all this cancer %$#@ and subsequent complications mean? What's the point? I feel like there is something I am yet to do, something bigger, but I don’t know what it is.

Three weeks post mastectomy, one week post second surgery, and I wish I could say I have some energy back, but nowhere close. I have discomfort and pressure on my chest 24/7, feel like there's fog in my head, have a headache that comes and goes. Internally, I think I'm still 30 years old, so am expecting my body to bounce right back. Then I remember I'm really 52. So I need to cut myself some slack. I need to become more patient — a virtue with which I will become very well acquainted in the coming months.