07.29.09
Under-Do??
I found this old draft and thought I would revisit some of the more pertinent issues I dealt with during my process. This post was originally started on 4/27/09, 11 days after my latissimus flap breast reconstruction surgery.
It seems as though practically over night, the color of the drainage has gone from Ruby Grapefruit to Apple Juice. I’m taking that as an encouraging sign. Although when I wake up, my back still feels like there are rocks under my skin.
Moving definitely helps. Though I’m not sure how much is too much. I don’t want to over do and hurt myself that way. But it seems that under-doing is just as bad and has the potential for lengthening my recovery. So I’m doing something I hate to do. I’ve told Ken that when he sees fit, if I’m not in pain, he’s to take me for a walk.
Poor Ken has to do so much. Not only is he taking care of me but he’s also keeping up with the household needs and the business. I’ve been so out of it, I’ve actually had to ask him on numerous occasions WHEN I need to take my meds.
The pain meds are really helpful but they’re draining me of the ability to think. It takes me about 30 minutes to write one of these daily entries. Granted, I am a lightweight when it comes to intoxication of any sort. But it’s still frustrating. I feel disjointed and I have no memory.
Eleven days after surgery I’m guessing that’s to be expected. It’s just really frustrating not being able to remember things that are really important. Like how long ago I took meds that could REALLY mess me up if I forget and take a double dosage. If I wait TOO long though, then there’s real trouble with the pain. Once the meds start wearing off, my options are 1) Take more or 2) Sit very, very still until I CAN take more.
The bad part is that if I wait, the it takes longer for the meds to kick in and they’re not as effective because they have more pain to battle. So I’m walking a very fine line here. And this is a line that my dear Hubby is in charge of because my brain is about as useful as cottage cheese.
07.09.09
M M M My Seroma
I posted about my check up yesterday. This morning the troubled spot will be left to heal. No more wet to dry dressings. YAY! It’s closing up nicely finally so that’s not an issue any more.
Now since I can’t seem to do anything half-ass-ed, while Dr. Guy was poking around on my back (and I mean that literally…poke…poke…poke) she discovered that the right side had a pretty massive seroma.
A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are ruptured, blood plasma can seep out; inflammation caused by dying injured cells also contributes to the fluid.
This isn’t a threatening or serious condition, though it could potentially cause complications down the line. The fluid is that yellowish slightly sticky stuff that bubbles up when you scrape your knee before the scab forms. A good idea of what a seroma looks like is here: http://tinyurl.com/n8ne2
It is evident the bruising is the skin is also distended and there is a large, softball sized lump where the fluid has collected. I was unable to find a photo of a seroma on the back. With a Latissimus Flap breast reconstruction, seromas are VERY common. From what Dr. Guy said, basically the pocket it causes makes the skin separate from the muscle. Until the fluid is drained or reabsorbed back into the body, the skin cannot reattach itself to the muscle. Basically the right side of my back from below the shoulder blade to my waist and in towards my spine was one gigantic seroma.
After giving me a local anesthetic, Dr. Guy excised the fluid by sucking it out with a needle the size of a harpoon. At least that’s what it seemed like. Ken says it was only an inch or two long and pretty small in diameter.
The Doc removed 455ccs of fluid. That is very nearly half a liter of fluid. She showed Ken how to tell if it builds up again. Basically he has to poke my back. If it ripples like a waterbed, there’s a buildup of fluid.
I have another check up in two weeks. I’m really hoping there will be no more fluid build up. As usual I’ll keep you all posted.
06.23.09
9 1/2 Weeks
From the title of the post, it’s pretty obvious what today’s topic is.
Medical updates.
The spot on my back is still troublesome. It’s not really getting any better. I’m still not too worried about it though as no one else at Dr. Elliott’s office is overly concerned. Last night Ken said he thinks I should “be seen” by Dr. Elliott’s contemporary down here, Dr. Roxanne Guy. I have an appointment for Thursday.
Honestly, I am SICK of “being seen”. I am SO over all of this medical crap. I just want to get ON with my life. I think that’s part of the reason I’ve started doing Ta Ta Tuesday. Even though I may not be completely done with all of this, I want to start enjoying the completion of the major stage.
The nurse at Dr. Elliott’s office had suggested that I wait another month to take the tape off the suture line. I got tired of waiting so I went ahead and took the tapes off four days early. Really I could have taken the tapes off at 6 weeks but I tend to be overly cautious as far as suture lines go.
I haven’t taken any acetaminophen for pain in a few days. I’m happy about that. It’s definitely a few steps ahead of where I was. My endurance, however, is another matter all together. I used to be able to be at Disney for anywhere from 12 to 14 hours. Now I can’t walk around for more than a couple hours without getting worn out. It’s possible that the heat could be exacerbating the issue, but I just don’t think so.
Mobility is another issue. I can raise my left arm all the way up next to my head. The skin in my armpit is still a little tight. My right arm is another matter. I can only raise it at a 55 or 60 degree angle without tightness and pain. It HAS improved since surgery. It’s just improving more slowly.
Emotionally I’m doing better, as the idea of TaTa Tuesday shows. I’m still trying to decide if I want to take a chance on nipple reconstruction. Some articles say that in experienced hands the failure rate is less than 2%. On other websites I’ve read women’s stories of how their nipples flattened out between six months to 2 years. There was also a fairly high incident of infection.
I have emailed Dr. Elliott and asked him to suggest someone who makes custom silicone nipples and write a letter of request. Every prosthetics maker I have found that does really good hand painted nipples requires a letter from a physician. Even if I decide to have the surgery later, I will still have the prosthetics in the mean time.
06.15.09
It’s More Complicated Than That
Something that isn’t really mentioned much is that eventually many breast implants may need to be replaced. An article released in 2005 by the New York Times reports that up to 93% of silicone implants fail within the first 10 years. http://www.nytimes.com/2005/04/07/politics/07breast.html .Those implants need to be removed and possibly replaced as soon as possible. This is another surgical expense that you will have to cover. Usually these costs must be paid out of pocket. In one study by the New England Journal of Medicine, the complication rate for augmentation was as high as nearly 25% http://content.nejm.org/cgi/content/abstract/336/10/677.
Other things surgeons are unlikely to tell you are that sometimes the skin thins and wrinkles and the silicone shell of the implant become visible. With saline implants, if you push on your breasts, you can hear the implant sloshing around. Ever fondle a breast with a saline implant? It feels like you’re fondling a water bottle. When it comes down to it, saline breast implants are really only good for looks. The other option is silicone implants. Although there is not a conclusive group of studies, it is widely believed that leaked silicone is responsible for, or at the very least, contributes to, autoimmune conditions such as fibromyalgia.
Sex may not be the same either. You have water bottles sloshing around in your chest that feel totally different from your natural breast tissue. Many women also report numbness or reduced feeling in their breasts and especially the nipples after augmentation. Sometimes it’s temporary. Sometimes it isn’t. This is surgery and it can cause permanent nerve damage just as with any other surgery.
Before you sign your paperwork for the surgery, someone in the doctor’s office will go over the list of possible complications. In my case the person stressed repeatedly that these complications were extremely rare. I’m sure that there are women out there who have gone through the procedure with no complications and no issues at all. I would LOVE to talk to one of these women.
The list of possible complications is as follows:
Seroma (pooling of serous fluid)
Hematoma (pooling of clotted blood; risk is 3-4%)
Symmastia
Double Bubble (also known as “double fold”, “snoopy effect”, or “snoopy breast”)
Mondor’s Cord
Bottoming Out
Deflation Photos (approximately 7%)
Capsule Contracture
Traction Rippling & Rippling Photos
Photos of these complications can be found here: http://tinyurl.com/5gz6mc
Other lesser complications include:
Asymmetry
Bleeding
Breast droop
Displacement
Implant leak
Infection (risk is less than 1%; always involves removal of implant)
Interference with mammography
Keloid (heavy scar)
Nerve Damage
Nipple numbness
Pain
Permanent numbness (risk is 15%)
Reactions to medications
Rippling
Rupture of the implant (often due to injury)
Skin irregularities
Sloshing
Slow healing
Swelling
Visible scar
The above are relatively MINOR complications, however. Seroma and hematoma can lead to necrosis because of the pressure on the small blood vessels reducing blood flow to the affected tissues.
Necrosis is the death of tissue. When necrosis occurs, the area must be debrided. This means that the dead tissue has to be clipped out and the remaining, new tissue cleaned. Debridement doesn’t hurt. That tissue is dead which mean there are no living nerve endings. To leave dead tissue is to invite infection. So even though the thought is terrifying (and believe me, it was TOTALLY terrifying when I went through it), it’s better to get it done and over with. Then the body has a clean bed of underlying tissue to grow from.
The complication percentages listed above are reported to be low. Most are under 10 percent according to the statistics I have found. This does NOT mean that surgery of any kind is completely safe. Do not believe that just because your friend had a boob job that went perfectly that you would have the same experience.
Your surgeon and his or her skill level play a big part. So does your body and how it heals. Even though I got a clean bill of health from my pre-surgical physical and blood test, I developed several complications. I had seroma and hematoma that were NOT addressed by my surgeon. I believe those contributed to the development of necrosis. I also talked to a nurse about a year after my complications. From the description of my waist to collarbone bruising, the nurse was completely convinced that something had gone wrong during the surgery that led to the development of the necrosis.
I’d like to stress again that you should be educated about your choice of surgeons. He or she MUST be board certified by a plastic surgery association. ANY doctors can call themselves a plastic surgeon but the ones who are actually educated for that specialty are board certified.
Do NOT try to find a deal. Trust me when I say that cheaper is NOT better. I learned this lesson the hard way. It cost me more than money to learn this.
If something does go wrong, you may not be able to sue. In the state of Florida a plastic surgeon is only required to carry $100000 in malpractice insurance unless they are affiliated with a hospital. By the time your lawyer proves malpractice, most of that $100K will be gone to lawyer’s fees. You will, in all likelihood have little to nothing left for any repair procedures.
Use my story as a cautionary tale. Know your body, know your family medical history, know your surgeon, and know the risks.
06.11.09
iHurt ver. 2.0
The last four days I have been much more active than I have been for the last eight weeks. We had two days of running errands, two days in a row at the salon getting my hair done and then fixed when all FOUR tubes of pink dye were defective, resuming “normal activity” (ahem)…three times and recording another episode of Chipped Plate Chronicles, our food review podcast. Yesterday I spent clothes shopping. By the end of the day yesterday I had to take not one but TWO Darvocet halves. I was spiking a four on the Oh-My-God-It-Really-Fuckin-Hurts Scale. Number One Son noticed that I was breathing raggedly and practically MADE me take the second 1/2.
I can’t just relax today either. I’m having lunch with Number Two Son who needs to talk to me about some things. WHAT things, I have NO idea. This means I must drive to his place, drive to wherever we’re going to eat, probably Panera in Viera, drive BACK to his place and then home. It doesn’t *sound* like much, but when you’re already tired and sore, it is.
More than anything, it’s my back that’s hurting. Since I have to drive I really don’t trust my skills while on Darvocet. This means using the acetaminophen. That wouldn’t be an issue if I wasn’t pretty sure that it’s contributing to my bruising problem. Which puts me back on the new non-aspirin OTC pain med that doesn’t seem to work unless I take two. Which isn’t good because the package clearly stated that I should only take one at a time. Unlike many others, I don’t subscribe to the “if one is good, two is better” mentality.
The safest choice right now seems to be the acetaminophen. I’m just going to take it as slow as I can today and tomorrow I’ll spend the day resting. I don’t seem to have much choice otherwise. Number Two Son is dirt poor and he needs his gas money to get back and forth to work. I’ll just do the best I can. In the mean time, iHurt.
05.21.09
Doctor Place
Yesterday was my one month check up with Dr. Elliott. After taking the tape off from over all the suture lines he announced that everything is looking fantastic. Even the spot on my back is just superficial. So I don’t need to see him again until after DragonCon in September!! WOOHOO!!
There is a red area just above the top suture line on my right breast and very mild bruising on the top of the left breast still but after prodding, Dr. Elliott said that he isn’t at all concerned. There is no thickening under the skin, it isn’t hot to the touch and there is no indication of infection. He thinks that it’s just the way my body is. So I’m going to defer to his expertise.
He also told me that I should leave the tape off the suture line for a week and give the areas a good (but GENTLE) scrub down with soap and water each time I shower. Then, next Wednesday, we’re to retape everything. I’m going to have to call next week and find out how long he wants me to leave the tape on this second time.
There was just one little tiny thing though. As the nurse took off the tape on the top, right side near the red spot, my skin actually tore open just a teeny tiny bit. They are just topical openings and very superficial though. It looks like I had been lightly scratched by a cat in two spots about 1/2 an inch long.
I have been unable to find any references to thin or delicate skin after my type of breast reconstruction. Perhaps it is simply my biology. It’s such a little thing though that I don’t really see a reason to worry about it. If it happens again, then I’ll worry about it. Right now I’m not going to borrow trouble.
The right side drain site is still leaking just a tiny bit of serous fluid. It also itches abominably at times which tells me it is healing. Annoying yes but it IS a step forward. It is still a bit tender but nothing like it was when the drain was still in.
We’ll be headed home to Florida tomorrow morning. On the way we’re going to meet up with my Mom. She hasn’t seen me since the surgery. I think she’s going to be absolutely stunned.
Which reminds me, I need to email the “After” Shot to my Dad. He’ll want to see that everything is just fine and he doesn’t need to worry anymore.
05.16.09
So I Was Wrong
Ken just changed out my wet-to dry bandage on my back and I got a chance to look at it. I’m a bit more concerned now than I was before. I know that everything is going to be fine in the end. At the moment though, the separation in the stitches is about 3 inches long. It’s not deep, but it is just chock full of glop at the edges of the opening. Tomorrow morning, if the wet to dry bandages haven’t removed more of it, I’m going to have Ken clean out the wound with antibacterial soap.
As usual, I will update as things progress.
Sucking Rocks Through A Straw
This is an older draft I found but I really feel like the issue of prescription drug addiction and the healing process in general calls for me to post this. Enjoy 
5/10/09: This morning I faced the conundrum that most surgical recoverees will face at some point: Hit the top of the pain charts by getting up or wet the bed. I had been blissfully asleep until my bladder woke me. Apparently it had also been quite some time since I had taken my last pain pill. So I laid there debating which was worse: Pain or Embarrassment.
I took Door Number One there Monty Hall.
Side Note: Speaking of Monty Hall and Let’s Make A Deal, *I* think that was an early instance of cosplay on the part of the contestants.
Now back to our regularly scheduled program: And I was right. My chest was screaming louder than it had since the end of Week 1. I’m starting to feel a bit like for every two steps forward I take, there’s generally this one little backwards stumble. First there was the over doing it with walking. Then it was the non-infection infection, Then came the Elephant with Barbed Wire Boots followed by the Darvocet Disappointment. Now this.
Recovery, while it IS a good thing and DOES continue forward, just has days where it sucks rocks through a straw.
In the mean time I’m still waiting for the Hydrocodone to kick in all the way. It’s better but there’s still pressure and the occasional muscle pain. Soon though. I can actually take deep breaths without wincing. That’s progress.
I’ve got to be careful about how often I take the Hydrocodone now though. I thought I had more than I do and every one of those halves is precious. Granted I DO have the muscle relaxers and those work too. So I’m just going to have to figure this out. OR I could do the smart thing and ask for a refill on the Hydrocodone IF it comes to that. Maybe Dr. Elliott will do it and be glad I’m off the Oxy. And for the record kids, I REALLY understand why doctors make that a short term med. It’s SO very addictive. When you’re on Oxy, you’re wrapped in a cottony cocoon where nothing bad ever happens and the world is filled with caviar dreams and champagne wishes. It’s a wonderful place that you really never want to leave. So of course at the first inkling of pain…even low level pain, you just pop that wonderful little pill and you’re back in that safe, warm place again. I could very easily see myself becoming addicted to it. So as much as I complained, it really is a good thing that Dr. Elliott switched me to hydrocodone.
05.15.09
Hooters
At 4:30 today I got the right side drain removed. YAY! I also found out one of the reasons that the drain site is so sensitive. Dr. Roxanne Guy said that there was something called “proud flesh” at the site. According to a medical website “Proud flesh is an excessive growth of granulation tissue that has the appearance of cauliflower. It usually develops over an open wound, and most often occurs in areas of excessive tension and motion”.
Granulation tissue is the perfused, fibrous connective tissue that replaces a fibrin clot in healing wounds. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size it heals. In other words it’s the brand new flesh.
In other words, my skin was trying to heal OVER the drain site and the drain was in the way. Since I only had one stitch holding it in (I tore the other one clear out last Friday night) the drain itself tended to wobble around causing tension at the site. On top of the proud flesh and raw granulation tissue, the site is also infected. AND there were fiberous tissue strands trying to come out of the drain as well. So it’s just been a pain fiesta at that drain site. 31 flavors of pain, to quote Scott Sigler’s book “Contagious”. Which, if you haven’t started listening yet, you’re SERIOUSLY missing out.
Dr. Guy also looked at one of the suture sites on my back. She removed a greenish string of matter about an inch and a half long from that site. It’s just a very small area but as a preventative measure she wants us to do wet to dry dressings for a little while.
A wet to dry dressing is gauze that has been dampened with saline and packed into the site. It is left for several hours to dry. When it is removed, it has stuck to the matter that needs to be removed so it debrieds the area. Debridement: The act of debriding (removing dead, contaminated or adherent tissue or foreign material)
Don’t worry, there isn’t any dead tissue. She just wants to make sure the little area gets cleaned up so that it will heal properly. I am not overly concerned. After what I’ve been through, a 1 1/2 inch long area is really easy to deal with.
After seeing Dr. Guy I was absolutely ravenous! I haven’t been that hungry in a VERY long time. So we stopped by Hooters since it was on the way home. It is SO nice to feel like I’m on par with these beautiful women. We sat and talked with our server, Ashley, about the state of the economy and other political things that I’ll spare you the details of since this isn’t a political blog.
Ashley WAS right about one thing though. The chocolate mousse cake there really IS almost better than sex.
Four Weeks
While the sutures are doing just fine, I’ve managed to develop an infection in the remaining drain site. The area is inflamed, pussy and a shade of red no skin should ever be. So back on Cipro I go for the next 10 days. I’m back to living on my heating pad, too. It’s the only thing that seems to make the drain site more livable.
Of course we reported the infection to Dr. Elliott’s people, thus the Cipro script. We were also told that the site needed to be cleaned with soap and water. It’s amazing the pain control you can accomplish with a focal point and slow exhalation during the cleaning process.
For those not familiar with the process, simply pick a spot that will keep your attention then take a deep breath and while the cleaning takes place, then control your exhalation keeping it very slowly and even. What this does is give you something else to think about, first. Secondly, it keeps you from gasping and screaming, or at least cuts down on the likelihood. When we scream we also tense up just as when we gasp. Staying as relaxed as possible is a key to any kind of pain management.
In the ‘good news’ department today, I got up this morning without taking any pain meds of any kind before getting out of bed. I *was* very stiff and sore, but I wasn’t experiencing pain like I had been previously. I do hope that this is the first step towards really being healed.
More good news: The level of drainage is starting to go down again. It’s still over 30mls in 25 hours but I think I broke the 50ml plateau finally.
Finally, in the ‘things you never thought you’d ever say in your life’ department, here’s an interesting tidbit. My mother is a 25 year cancer survivor. She had Stage 2 breast cancer which means that it had spread to her lymph nodes. The doctors performed a double radical mastectomy. At that time in Wyoming they weren’t doing breast reconstruction at the time of the breast removal. She was told she had to wait two years before she could have reconstruction.
Two years later she decided to just do implants because it was easier rather than any of the flap procedures. She told me she didn’t do her homework like she should have. Unfortunately, she developed necrosis and had to have both implants removed. She never had them replaced out of fear of having the same problem nor has she had any type of breast reconstruction surgery.
With her own experience and my previous experience she has been scared to death. Of course I wanted to reassure her that I am doing well. I also wanted to show her the marvelous work that Dr. Elliott did. So I text messaged her a pic that I had taken of the Twins at the 4 week mark. She said something I never thought I’d ever hear my mother say to me. “You have beautiful boobies”. Yes it’s a little freaky to hear something like that from my mother. It’s nice to know that she IS reassured though.
She has told me that if she ever decided to have reconstruction done, Dr. Elliott is the ONLY person she would trust to do it. I’ve said it before, but I cannot say it often enough, I cannot recommend Dr. Franklyn Elliott of Atlanta Plastic Surgery AND his staff highly enough. They have been absolutely amazing throughout the entire process.
