Posted: February 18, 2011 | Author: pinkunderbelly | Filed under: breast cancer, infection | Tags: Barney Frank, Boston, breast cancer, construction, DIEP, ET, haz-mat, I-93, infection, Methodist Hospital, new boobs, nurse practitioner, plastic surgeon, reconstruction, the Big Dig |
Yesterday was yet another trip to the medical center, for one last pre-op visit to Dr Spiegel before reconstruction. I really need to think of a catchy title for the surgery, something like Boston’s big construction project, the Big Dig. Come to think of it, there are some similarities between the Big Dig and my surgery: both relate to the Central Artery and Tunneling (in fact, the official name of the Big Dig is the CA/T Project). Both are complicated, involve lots of people, and take a mighty long time to complete. But unlike the Big Dig, which replaced the 6-lane elevated Central Artery (I-93) with a 3.5-mile long underground tunnel, my surgery won’t cost $22 billion. Hopefully. My insurance company, which has been mighty nice so far, might just stroke out about that figure. 
The Big Dig sounded like a great idea and was intended to be a tremendous boon to an already kick-ass city. But mismanagement, scandal, and skyrocketing costs quickly dominated headlines, and my second-favorite city had a big mess on its hands. Congressman Barney Frank quipped, “Wouldn’t it be cheaper to raise the city than depress the artery?”
Say what you will about Barney, but that’s a good line.
But back to the update on the doctor visit. This was Trevor’s day to meet the lovely Dr Spiegel, her ultra-energetic PA, Jen, and her trusty nurse Sonia. My friend Laura, who is a nurse practitioner in the liver transplant unit at Methodist, met us there, too. Dr Spiegel wanted to brief my caregivers on what to expect post-surgery, and Laura kindly offered to help out. In her white coat and super-stylish glasses, she brought a nice element of professional gravitas to the occasion. She told Dr Spiegel that she’s done some match-making for me and picked out an anesthesiologist she likes and trusts, and Dr Spiegel agrees that Dr Ashmore is the guy for me. Laura and Sonia recognized each other right away, then she and Jen hugged and high-fived, happy to be collaborating on my case. It’s good to have connections.
The visit itself was pretty uneventful. I like uneventful at the doctor’s office. Dr Spiegel went over a few basics with us but since we were pretty much up to speed on everything, there weren’t any new developments. I’m finished with all the pre-op testing (bloodwork, blood donation, x-rays, EKG, CT-scan), and just need to watch the video consultation on Dr Spiegel’s website to get a more detailed overview of the procedure. I’m not saying I’m scared to do that, but after watching a video on youtube of an actual surgery, on an actual person, I’m not in a big hurry. Ick.
The one topic we did need to cover, though, was the infection. I wanted to bring it up in a way that seemed breezy and conversational, as opposed to, “How the sam hell are you going to keep this bloody nightmare from recurring, lady?” I was pretty sure that wouldn’t go over too well.
I’m not the most diplomatic person, and I tend to say what I really think, even if it’s not pretty or may be hard to hear. It’s a blessing and a curse. Believe it or not, I actually do put a lot of thought into what I say and how I say things, but because I’m pretty direct, sometimes things come out a bit, um, harsher than I intend.
Sorta like, “Are you outta your mind??? You’re not really going to wear that are you?” or “Clearly that person has neither friends nor a mirror; why else would one go out in public looking like that???” as opposed to “Have you thought about what to wear?” Those kinds of niceties take a bit of work on my part. My instinct is to just blurt out whatever needs to be said, and let the chips fall where they may. We’re all grown-ups, right?
Right. Except I really don’t want to tick off the nice lady with the very sharp scalpels. That would be bad. So I fumbled around and probably sounded idiotic by saying, Um, so, uh, like, how worried do we need to be about the um, you know, infection? You know, like, um, during the uh, reconstruction?
She smiled knowingly, and if she’d been sitting closer might have patted my hand and said, there there. She reminded me that my case isn’t exactly normal, and I tried not to tell her that “normal” is pejorative and listened to what she had to say.
She has a plan, of course, and it sounds like a good one. Usually, in cases of infection, she would wait to do reconstruction, to be sure the infection is truly gone. But in my case, which again is not normal, we need to get in there sooner rather than later and clean up the mess, i.e., excise the damaged tissue and replace it with some new, fresh meat. And by meat I mean my own flesh. Fresh flesh. Yum.
The plan is to work on the infected side last, and she promised to take her time and wash it all out thoroughly with 6 liters of antibacterial solution. That’s way more than usual. She’ll have separate fields of instruments, and once the instruments touch the infected area, they’ll be classified as contaminated. Remember the scene in the movie ET at the end, when the little guy was dying, and the family home was a warren of plastic sheeting populated by feds in Haz-mat gear? I’m having visions of the Haz-mat suits. But hopefully no aliens. Although I do kinda like the polka-dotted kiddie pools in this scene.
So we’re on track, on schedule, and presumably ready to go. She estimates the surgery will last 8 hours, not 12-15 like I’d originally heard. Of course, we won’t know what we’re dealing with until she actually gets in there and starts cutting and scraping away, but I’m going to be optimistic.
Meanwhile, I’ll be thinking of a name for my own personal Big Dig (if you have ideas, send them em!), and can’t wait to post before and after pictures like this:
Except, I won’t make you look at the before pics, because they’re pretty gross, and that would just be mean.
Posted: January 7, 2011 | Author: pinkunderbelly | Filed under: breast cancer, drugs, infection | Tags: BBQ, breast cancer, champagne, DIEP, homework, hospital, implants, infection, mastectomy, microsurgery, mycobacterium, new boobs, plastic surgeon, recovery, ribs, SIEA, surgery, tennis, the South, tissue expanders, TRAM flap |
I’ve been reading up on and researching reconstruction. Oh, to return to the days in which the only context I had for reconstruction involved the South rising again.
Alas, that’s not to be, and the horse is out of the barn, the worms are out of the can, and we can’t unring that bell. So now reconstruction means something entirely different.
It was supposed to be a pretty simple affair: tissue expanders put in at the time of my mastectomy, which would be filled with saline slowly and gradually, over a period of a few months, to allow my skin to stretch and accommodate a set of perky but modest implants (male readers, go ahead and groan at the mention of modest implants.) Why does one need her skin stretched for implants, when millions of women get the orbs jammed into their chests in a single step? Because those millions of women haven’t had their flesh scooped out down to the ribs. (Hope you weren’t planning on eating BBQ anytime soon.)
Back to the implants: my simple affair turned in an epic fail when the right tissue expander exercised some really bad judgement in allowing a mycobacterium to share its space. Ah yes, the infection. That dadgum bug turned my world upside down, and fast-tracked me from post-surgery superstar to sick, sick, sick. My recovery was going so well. I was convinced I’d be back on the tennis court in a month. Sigh.
Moving along to option B: the TRAM flap. It’s a big surgery (8-12 hours average) with a week’s stay in the hospital and 3-to-6-month recovery. Youch. I didn’t really get how they accomplish this surgical feat, so in the course of my research I watched a youtube video of an actual TRAM flap procedure. “Ewww, gross” doesn’t even begin to cover it.
In laymen’s terms, the surgeon cuts a football-shaped piece from your tummy, with the incision going from hip to hip. He or she (for this purpose, we’ll say “he” since Dr S will be the surgeon, but y’all know I’m all about equal opportunity so I must digress) then cuts the rectus abdominal muscle, in its entirety or partially, and uses that muscle as the blood supply (e.g., blood vessels and small arteries) in the newly created breasts. Then he tunnels his way from the tummy incision up to the breast area, shoving tummy fat upward to create the new breasts.
After recovering from the grossed-outed-ness of watching this, I marveled at the ingenuity of the technique. Pretty cool stuff. But I admit it unnerved me for a few days. You may recall from previous posts way back when this all started that I HATE hospitals. I detest the smell, the noise, the lack of privacy, the parade of people in & out of the room, the clanking of carts up & down the hall, the cafeteria-style food, the machines beeping, the cords snaking everywhere, and the omnipresence of needles and IVs. I do like the morphine, though.
In addition to my extreme and unconditional hatred of all things hospital, I now fear them greatly and mightily because of the infection. I’m really, really scared. Like “want yo mama scared.” The risk of infection in any surgical procedure is estimated to be 3 percent. That’s pretty low, right? When you think about all the different surgeries done in all the different hospitals in all the different cities every day, that’s pretty low. But leave it to me to be the one person who gets it. Sheesh.
And leave it to me to get a rare infection that is not only hard to classify but hard to kill. Hence the never-ending 12-hour cycle of oral antibiotics. A quick back-of-the-envelope calculation tells me I’ve been taking those two oral abx for about 140 days. And there’s no end in sight.
So you can see why I’m not exactly rushing back into the OR for my reconstruction.
However, the compelling reason to get in there and get ‘er done is the complications still arising from said infection. Dr Grimes, my infectious disease doc, thinks that undergoing the surgery sooner rather than later will help clear up some of those complications by way of cleaning out the unhealthy tissue and replacing it with fresh new tissue with a brand-new blood supply. Sort of like replacing your old, threadbare socks with a nice new pair.
That’s why I was doing my homework and scaring myself half to death, so that I can go into my appointment with Dr S armed with knowledge and ready to proceed. I took a lot of notes and tried to keep up with all the different kinds of flap procedures: pediculed vs non-pediculed vs perforated, etc. Then there are variations on the procedure called DIEP and SIEA flaps (Deep Inferior Epigastic Perforator and Superficial Inferior Epigastic Artery, respectively). Prior to my research, I had no idea what TRAM stood for but speculated, based on my limited knowledge, that it was “That’s Rough on your Abs, Ma’am.” Turns out it’s actually Transverse Rectus Abdominis Myocutaneius. Good to know.
I didn’t pay much attention to the DIEP and SIEA flaps, because the TRAM flap was the only procedure Dr S had ever mentioned. I assumed that’s what I’d be getting. We all know what happens when you assume…
Dr Dempsey pointed out, however, that the DIEP flap is the one for me because it spares the ab muscle, something I will want and need as I go forward in my long, active, tennis-filled life. The DIEP flap is a more complicated surgery (12-15 hours), though, and there’s not nearly as much info available on it as there is on the TRAM flap.
Here’s why: the DIEP involves a lot of microsurgery. Instead of transferring the ab muscle and its blood vessels to the breast area, Dr S will make that big incision on my tummy, but leave the muscle there, removing the blood vessels and arteries entirely and reconnecting them in the new breasts. Apparently he will have to cut a piece of a rib, too, to make this all come together. I choose to skip over that part and not even think about it. Yikes.
The DIEP is considered the gold standard of flaps. And the reason there’s not as much info available is that it is a more technically complicated surgery, and not many surgeons do it. But if you’ve read any of my posts about Dr S, you know that he is the gold standard of surgeons, so I’m in good hands.
Stay tuned.
Posted: November 21, 2010 | Author: pinkunderbelly | Filed under: breast cancer, tennis | Tags: best friends, breast cancer, breast implants, cancer battle, cancer diagnosis, champagne, mastectomy, pink ribbons, plastic surgeon, recovery, saline, shoes, shopping, surgery, survivor, tennis, tissue expanders, TRAM flap |
You’d think that having a friend going through the worst thing you’ve ever faced would be a comfort. And it is, kind of. It’s also really hard and really sucky, because as great as it is to know that she truly gets what I’m feeling, it means that she’s probably feeling it too, because she’s in the trenches herself.
Does that even make sense?
It does to me, but if you’re having trouble following along, bear with me. My friend in the trenches is staring this vicious beast in the eye, going toe-to-toe with the roughest part of the “cancer journey.” (I really hate how that phrase conjures up a nature walk or space travel or anything other than what it is, which is hell. For lack of a better phrase, I’ll continue to use “cancer journey,” but I insist on taking away some of its power by using quotation marks.)
She and I had a great day together yesterday. I took her to her appointment with Dr S., which is always fun for me because I’m not the one sitting on his exam table. She was getting her tissue expanders filled, and I’m going to risk embarrassing her a little here by saying that girl is starting to become stacked (yes, I’m envious, but so so so happy for her at the same time). I also had gotten my tissue expanders filled a few times this past summer, before the *&$% hit the fan and “mycobacterium” became part of my lexicon, so I knew what to expect from the procedure.
What I didn’t expect was to get to be Dr S’s assistant. Nurse Nancy in the house! Dr S’s lovely nurse Brenda was on vacation, so Dr S told me to glove up and earn my keep. I couldn’t resist asking him if the gloves were latex-free, even though I don’t have a latex allergy. It’s not much, but it’s all part of how I drive him batty.
I’ve witnessed him bossing Brenda around plenty, and it was funny to be on the receiving end of that. We were in the midst of a heated discussion about something or other, and he started ordering me around right away. I reminded him that it’s nice to be important, but it’s important to be nice. He loved that one. Really. My poor sweet friend asked us to stop fighting and please talk about something sweet, like puppies or Easter bunnies, since Dr S was waving a giant needle around as she lay helpless in his wake.
He told me to hold the bag of saline a certain way, so he could jam the giant needle into it and fill up the king-size syringe to then insert into her tissue expanders and fill them up, and I couldn’t resist doing it the wrong way, just to tweak him. Then I realized he was pointing the giant needle at me, coming toward the saline bag, so I decided to shape up. It’s all good fun.
Before we made it into the exam room, she and I waited quite a while in the waiting area (I sure hope this isn’t becoming a trend with Dr S, because I hate to be kept waiting). We were chatting and laughing, and an older lady was watching us. She finally interrupted our conversation to tell me she liked my boots, and to ask if she’d seen me in Dr Darcourt’s office earlier that week. She and I apparently have the same oncologist and plastic surgeon. Small world! She asked my friend and I where we both are in the reconstruction phase, and we compared notes as girls in our situation tend to do.
This sweet lady shared that Dr S had done the TRAM-flap procedure on her 5 weeks ago. I said, hmmm, that’s the procedure he thinks he wants to do on me and I’d love to talk to you about that. Good grief, did that open the gates to a gush-fest on how wonderful Dr S is. This lady and her husband both couldn’t say enough nice things about him. If they said it once, they said it 100 times: “He’s not a surgeon, he’s an artist.”
That’s sure nice to hear. I’ve heard it before, actually, from lots of different people. But it’s still nice to hear. Especially just before my friend and I got called back into the exam room for her turn. It made me give him a little bit of extra grief, just because I know he’s so full of himself. And because I know it makes him nervous to know that I’m talking to his other patients. He’s asked me not to mention the whole infection thing, just in case that unfortunate event is associated with him. Easy enough, as I’d like to forget it ever happened. And easy enough because never in a million lifetimes would I ever believe that it was his fault. I’ve said before and will say again, repeatedly, that man drives me crazy but he took good care of me. The problem is that when someone asks why I haven’t started moving forward on reconstruction, as this sweet lady did, it’s kinda hard to answer honestly. I can always lie and say I’m a big chicken who can’t face another surgery, or I’m indecisive and can’t figure out which option to choose. But neither of those are nearly as compelling a story.
After we concluded our business with Dr S, we ran a couple of errands before meeting some other friends for lunch. And by “ran a couple of errands” of course I mean shopping. We were on a mission to find her a new pair of black boots and I’m proud to say that we found not only the boots but also two other pairs of shoes. I’ve written before about the healing power of new shoes. It’s a force unto itself. She and I both really believe in the power of great shoes. The rest of our worlds may be a crumbly mess, but we’re gonna face it in great shoes.
We spent a lot of time laughing so hard we hurt, and more than one person stopped to look at us and probably wonder what in the world could be so funny. She’s not the sort of person who snorts when she laughs real hard, but I am, and I did it a few times. That’s how you know you’re really laughing. I’ll bet that to the outside world, we look like two normal women: hanging out, enjoying each other’s company and relentlessly pursuing the perfect pair of black riding boots. Probably no one notices that we both have a port bulging out from under our skin, or that we have a much different profile than we used to. I know that no one can see the scars under our shirts, and the newly-etched worry lines on our faces could be from any number of stresses. No one knows that the landscape of our daily lives has a completely different topography now. Instead of just being filled with carpool and tennis and such, it now revolves around doctor appointments, procedures, and research. When we’re out in public, running our errands and getting stuff done, we look like normal people. We get through our days, cross things off our “to do” lists, and take care of our families, just like everyone else. But we do it with a heavy burden. That’s why it was so great to spend the day together, and to ease each other’s burden, if only for an afternoon.
Posted: November 14, 2010 | Author: pinkunderbelly | Filed under: Uncategorized | Tags: breast cancer, cancer battle, cancer diagnosis, check-up, Daylight Savings, infection, mastectomy, new boobs, plastic surgeon, plastic surgery, recovery, survivor |
It’s been too long since I’ve posted a good story about Dr S, my most-favorite and much-abused plastic surgeon who saw me through the worst of the infection(s) this past summer and with whom I have an ongoing love-hate relationship. I love to needle him, and he hates to see my name on his clinic schedule!
I saw him Friday for a check-up (I love the way “check-up” sounds so simple & innocent, and misleadingly free of scary stuff like tumors and fat necrosis and scar tissue and reconstruction). He’s usually pretty prompt, and out of the many, many office visits I’ve had with him, I really haven’t had to wait too long for him. The few times it has happened, though, it has made me mad and I let him know it. I understand that delays happen, and the doctor isn’t always in control of the schedule, but I’m just an impatient person and it annoys me. My bad.
Friday was no exception. After waiting nearly an hour in the waiting area (so aptly named, that place), I waited some more in the exam room. I’ve explained before that although I am “just” an at-home mom, my time is still valuable, and I prefer him to keep some other patient waiting and get to me first. Not that I want some other patient to have to wait longer than me, but really once you’ve been diagnosed and gone through a nasty surgery and then the whole infection scene and multiple hospitalizations, well, ok maybe I do want someone else to have to wait longer. Surely all of that mess garners some sort of street cred or extra credit or something that allows me to go to the front of the line. But no. Like so many things related to cancer and subsequent recovery, there’s no easy way, no priority boarding, no free ride.
So after an hour of waiting on Friday, Amy and I were joking, as we’ve done before, about the many ways we could get his attention. We can usually hear his voice through the exam room walls and can gauge if he’s wrapping things up with the previous patient (although sadly, we can’t make out all the words and so can’t really get a sense of what they’re discussing, and y’all know how nosey I am; being able to properly eavesdrop would pass the time quite nicely). We’ve considered texting him from the waiting area and the exam room (yes, I do have his cell number), or knocking on the walls and hollering, Hurry it up in there, we’ve got to get back to Sugar Land for carpool!
Well on Friday we hatched a new plan and decided to write him a note and slip it under the door. We ripped the paper covering from the exam table and scribbled, You’ve got 5 minutes. Then we stuck it under the door.
Ballsy? Perhaps. Rude? A little. Effective? Most definitely. He burst through the exam room door post haste, note in hand and grinning wildly. He needed a little shake-up to his day. He muttered something about how he’s never in all his years had a patient give him so much grief. I replied that I’ve never in all my years liked waiting, something I’ve been imminently clear about from day one with him. Y’all may recall from my previous blog on Caring Bridge that I told Dr S at our first consultation, shortly after my diagnosis, that I know full well and good that he has other patients; I’m not his only patient, but I expect to be his number-one priority. I was kidding then, but oh how eerily prescient that little wisecrack turned out to be. Six months later–and today is exactly six months since my mastectomy–that man is still not rid of me.
Here’s the really funny part, though — he actually tried to blame his lack of punctuality on Daylight Savings. He said his schedule has been messed up since the time change, and I guess what we’re supposed to infer from that is that it’s not his fault. Time change, huh? It must have been pretty clear by the look on my face that I wasn’t buying that, because he asked me why I was looking at him as if he were FOC. I wasn’t familiar with that acronym so he said what about FOS? That one I know, and told him that I did indeed think he was FOS. Totally FOS. Since we “fall back” with the time change, he should have been an hour early!
Yesterday was yet another trip to the medical center, for one last pre-op visit to Dr Spiegel before reconstruction. I really need to think of a catchy title for the surgery, something like Boston’s big construction project, the Big Dig. Come to think of it, there are some similarities between the Big Dig and my surgery: both relate to the Central Artery and Tunneling (in fact, the official name of the Big Dig is the CA/T Project). Both are complicated, involve lots of people, and take a mighty long time to complete. But unlike the Big Dig, which replaced the 6-lane elevated Central Artery (I-93) with a 3.5-mile long underground tunnel, my surgery won’t cost $22 billion. Hopefully. My insurance company, which has been mighty nice so far, might just stroke out about that figure. 
The Pink Underbelly 