One Week of Healing.
Well, it has been a week since my my bi-lateral mastectomy surgeries. There’s been little to no pain - which I attribute to perhaps an over liberal dose of anesthesia that lingers in my system days later. It's the sleep deprivation, mostly that's driving me crazy. I'm usually a productive person but this really takes me out. The chest binding isn't that much of a bother but the fact that I have to sleep in an incline and not raise my arms above my head at least for the month or however long, which makes getting good sleep the unattainable dream. So I'm taking little cat naps all day. On the plus side, I had two of my 4 drainage tubes removed yesterday. Yay!
Anyways, I’m getting ahead of myself. Where was I? Oh yes. Things have gone relatively smoothly since the operation, I can’t complain. So much change in a week! The mastectomies, the post-op wake up, the bandages & tubes, sleeping on an incline and the accompanying sleep deprivation.
The day of the surgery, I had a 5:30am check-in time at the Intermountain Medical Hospital in Murray. So we got up at 4:30 in the dark, and drove to the hospital. I don’t remember much except a little of the conversation I had with the doctors, right outside the operating room and being wheeled in. I kind of expected to be awake for when they drew the lines on me for cutting, mostly because I was curious, but that part isn’t in memory.
The surgery itself. Since I had received the phone call diagnosis late last year on the 21st of December, Winter Solstice,I had been planning for this date. The diagnosis was DCIS, ductal carcinoma insitu, a 0 grade cancer of the milk ducts in the left breast. The plan was to do a mastectomy in the left breast as well as the right breast. This was because I had a strong family history of bilateral primary breast cancers in the family: my mother had two primary cases at 36 & 40 and my maternal grandmother at 40 and 60. So I expected the other shoe to drop. If I could get insurance to pay for both mastectomies at once, then I figured why, not, since this would halve my prospective healing time. I really didn’t want to wait until the right-breast came up with cancer, which I felt would be inevitable, first before going and having a second separate procedure.
So since I got the okay or “pre-approval” from insurance I opted to get as much done in one go as I could. I figured that I might as well get all the healing (translated - waiting to continue on with life as usual) done in one go and while I am young. So this is what I had done.
Bi-lateral mastectomy: the general surgeon meets ahead of surgery with the plastic surgeon and discussed incision lines and they draw all over me (presumably I’m asleep). Then the general surgeon goes in, starts on the cancerous breast and does a sentinel lymph node biopsy first. This is where they feed dye into my system from the site of the cancer and see which lymph nodes are colored first. They then remove a few of these lymph nodes and test them, immediately for cancer. If cancer is found, then I guess they would continue to remove more lymph nodes until it was no longer found. In my case my first nodes were clean. Then the general surgeon removes the breast tissue. She would then start on the second breast, and the plastic surgeon would begin work on the first breast.
Reconstruction: reconstruction will take up to a year and a half to complete in several diminishingly less major procedures. In this first one, after the breast tissue has been removed in a skin-preserving mastectomy, the plastic surgeon comes in and attaches a non-cellular graft made with material called alloderm to the front of my chest muscle wall. The graft will function as a pocket for future breast implants. Right now, it will be home to a temporary tissue-expander that starts out empty. The tissue expander has a neat magnetic port that will allow the plastic surgeon to locate the port from using a magnet on my skin surface so that they can fill the tissue expander with fluid. Over the course of a few months, the tissue expander will be filled to the desired size and the skin stretched accordingly. Eventually a more permanent implant will be surgically placed in place of the tissue expander.
What I do remember is waking up in the post-op waking up area and throwing up (or maybe it was dry heaves?). And I remember there be a lot of expectations that i would be ready to leave hospital soon, and me getting a sense that I should be a lot more awake, according to everyone else’s plan. But my body wasn’t having any of the waking up business. According to Erik, the expectation would be that I would leave hospital at 2pm. However, he overheard the nurses discussing possibly keeping me overnight, since I wasn’t really waking up properly. I kept waking up and going right back to sleep. I wasn’t until 4pm that I was able, with much struggle, to stay awake long enough for them to discharge me. Even then it was a very unpleasant struggle to stay away and engaged. I posit that this was an issue of general anesthesia perhaps not having a good handle on how to dose people at my end of the weight spectrum?
During the first few days, I'm better. Better yesterday and about the same or today. Dizziness is much reducing & sleepiness is less and managable. And I'm getting up to walk for 10 mins , every 50 minutes to reduce the potential for post-operation blood clot ans stroke risk. I'm bored and low energy, but making progress. The worst is sitting there watching the Erik help with emptying and measuring my drainage bulbs (attached to tubes in my sides).
Erik has been taking this as a teaching moment and involving the girls in witnessing the drainage maintenance (Wivi helps with getting the alcohol wipes ready for wiping the caps of the drainage bulbs after they are emptied into graduated cylinders for measure and tracking fluid volumes) & also he involved the girls in setting up a drug spreadsheet. The pharmacy offered eight different drugs , they are all on the spreadsheet but I'm only taking 2 of them, really: the required anti-biotic and an extra strength ibuprofen. The other drugs are all pain meds or meds given to counteract side-effects of pain meds. One opioid (which I avoid like the plague on account of the nausea and potential for constipation), two to counter-act the opioid for anti-nausea, another to counter-act the opioid for as a stool-softener, and extra strength tylenol and an extra strength ibuprofen. On the first couple of days I actually took some of the anti-nausea and stool softener, because it felt as if the anesthesia medications were still slowly filtering out of my system, so linger nausea and other such fun. Yay.
I got my first post op appointment on Tuesday. I couldn't wait to get the tubes out, but that was still to be 8-9 days away.
It took me a while to realize, but after a few days I realized that ibuprofen wasn’t really necessary, and that the things that were bothering me were either superficial (as in on the skin - chafing and such) having to do with sleep positioning. After a few days I wasn’t on any pain meds and my real irritations were having my chest bound tight in compression ace bandages wrapped around a compression surgical bra, in combination with having to sleep at an incline so as to prevent me from raising my arms above my head in sleep. So I don’t sleep well, even with a full night’s rest and I get to be sleep-zombie for a month or so.
Tuesday’s appointment: the nurses took off all of the bandages and my plastic surgeon looked over my skin and we went over the log of the drainage volumes. Things looked good.
***The Pathology Report***
Wednesday pathology report! I received good news and shocking news from my general surgeon, when she called with the pathology report. The initial pathology that they had run on my sentinel lymph nodes was good, none of the nearby lymph nodes showed cancer. The breast tissue was then sent to a lab to do further study. The lab confirmed that I did indeed have DCIS in the left breast as was indicated by screening. The shocking news was that the laboratory also reported that there was a presence of DCIS in the right breast that had been missed in the screening. So good news, in that both cancers were caught early and the work on them is finished. Shocking still is the second cancer diagnosis.
What are the odds? From a casual internet search, February 10, 2023 on Google, it’s about 2.3% or so, “How common is it to have breast cancer in both breasts at the same time? National Breast Cancer Audit data shows that an average of 2.3% of women with invasive breast cancer in one breast also had cancer in the second breast diagnosed either at the same time, or within three months of the first diagnosis. This is called synchronous bilateral breast cancer (SBBC).”
***Progress***
Thursday’s appointment: I got two of my four drainage tubes removed!!! It was a little freaky to feel the tubes being pulled out from under the skin on my chest, but it wasn’t really painful and the process was quick. He taped me up and sent me off in a new compression bra (pink this time) and more ace-bandage wrappings. This time the doctor did a cross-your heart type of wrap so the the ace-bandage couldn’t scoot down and off of my chest like it had been doing.
The drainage tubes were for healing. Since they grafted in an inner-pocket to the front of my chest muscle wall, they are trying to ensure that all the layers that should laminate together in the healing process are coming together. The compression and wrapping across the chest along with the drainage tubes that allow any of the remaining of fluid (lymph and blood) to escape and get out of the way of lamination, make sure that the layers are sandwiched tightly and knit to together well. It's really interesting when you think about how much plastic surgery still counts on the body to do its job properly.
My next appointment is in a week, next Thursday, I hope that I can have the rest of my tubes taken out then. But what I really look forward to is being able to freely move my arms - someday again, when I get the okay from the docs. Right now I’m to restrict my arm movement also to ensure that there is as little shear disturbance to the healing and lamination of the new graft.
Comments
Post a Comment