Introducing the New Dr S

There’s a new Dr S in my life. I’m happy to introduce Dr Aldona Spiegel. 

She’s purty.

And smart.

She’s younger than me and has 3 kids, ages 6, 2 and an infant. She’s tall, slender and blonde. And she’s a renowned surgeon. If I didn’t like her so much, I might hate her a little.

But she’s gonna build my new boobs, so I love her.

We had a fantastic consultation today. Every aspect of her office, from the atmosphere to the staff, is first-rate. Beautiful waiting area, pleasant receptionist, warm & friendly nurses, a big Mac (computer, not burger) in the exam rooms, a fantastic physician’s assistant, a comprehensive bound photo book of before & after pictures of her patients, and of course the lovely doctor herself.

According to her website, “Her goal is to provide not only the most advanced breast restoration procedures, but also a caring and supportive environment—allowing each woman to complete a successful rehabilitation from her breast cancer battle.”

I like that. I’m especially intrigued by the idea of rehab from my battle. Sounds good.

How about this: “Dr. Spiegel is committed to providing superior, patient-focused care and preparing the next generation of surgeons to meet the highest standards of excellence. This vision combines a dedication to advanced research, exceptional education, and the development of new, less invasive treatments and procedures.”

Great!

She trained in general surgery at Johns Hopkins Hospital and did her fellowship in reconstructive microsurgery and specialization in plastic surgery at Baylor College of Medicine where she was served as Assistant Professor of Plastic Surgery. Dr. Spiegel has trained with leading reconstructive surgeons around the world, developing and improving upon techniques to help minimize the aftereffects of breast cancer on a woman’s body.

This just keeps getting better and better!

Here’s where we get into the medical mumbo-jumbo: “Dr. Spiegel’s clinical expertise is in advanced breast reconstruction techniques and microsurgery, particularly in the area of surgical reconstruction with reinnervated autologous muscle-preserving perforator flaps, including the DIEP Flap, SIEA Flap, SGAP Flap, TUG Flap, and the TAP flap. Dr. Spiegel also specializes in Lymphedema Procedures, advanced Implant and Latissmus reconstruction, and has pioneered Sensory Innervation procedures which have the ability to reestablish sensation to the breast resulting in the most complete form of breast restoration. In addition, she is interested in all aspects of aesthetic surgery and is committed to women’s health issues in plastic surgery.”

Sweet. She is the total package.

The only complaint I have is with the panties. 

They were made of paper. And small. Really small. I spent a few seconds staring at them before thinking, one size does not fit all.

Egads. Cue the humiliation. Again.

Luckily, I’ve been humiliated in a doctor’s office before, so I’m ready for it and ok with it. I slipped on my pretty blue paper panties and the matching blue paper gown and prepared to meet my new savior, Dr Spiegel. I’m so glad I’m past caring about meeting a beautiful and successful doctor while wearing the most unflattering paper garments ever.

She answered all my questions, most importantly the one about weight gain. I’m good, I’m fat enough and don’t need to gain any more.

Whew, that’s a relief. I was getting pretty tired of drinking beer & eating chips. Now that I’ve bulked up, I am free to return to my normal, healthy eating. She said she would prefer to have a bit more building material, but she can work with what I’ve got, so I don’t have to worry about applying for a new zip code for all the junk in my trunk.

Now that’s a relief.

She’s planning my reconstruction, and it’s going to be pretty great. I’m actually starting to envision an end to this long, bumpy road. As much as I detest the idea of another hospital stay and recovery, I’m looking forward to closing the book on this chapter of my life. It’s such a cliche, but it’s true. Reconstruction is a big, scary step. I totally understand why some women never do it. And if not for the infection and the mess it left behind, I wouldn’t be in any hurry to do it myself.

But the infection did leave a nasty mess, and it continues to wreak havoc, and the best way to end that madness is to excise the tissue (again), and replace it with new tissue and a new blood supply.

It means a long surgery, a night in the ICU, and several additional nights in a regular room. Ugh, yuck, and ick. But, it will all be worth it when it’s done and I can say I’m truly on the other side of this wretched business.

Stay tuned.


Homework

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.