10.24.09
Debridement
It sounds scary. I was terrified when the HIQ said that at the next appointment he was going to “remove the dead tissue”. I anticipated pain. I even had a panic attack. As if I wasn’t enough of a basket case as it was. I didn’t even get an explanation as to how it would be done.
By this time I was crying at least once a day. It had finally sunken in that things were really bad. I had lost both nipples and areolae. The tissue was completely dead. The tissue itself was blackened and rubbery. In some places it crackled when I pushed down on it. So it had to be removed.
Dead tissue is a breeding ground for infection and if it wasn’t removed, it would have caused infection that would have gone systemic and eventually killed me. So debriding, even though it sounds terrifying, is actually a good thing.
When we came back for the next appointment, the HiQ STILL didn’t explain exactly what would be going on. Thankfully his nurse did. She explained that this wouldn’t hurt because the tissue he would be removing was dead so the nerve endings were dead too. Because the nerves were dead, there wouldn’t be any sensation except for a pulling sensation.
I sat down and kept my eyes closed the entire time. I do know that he cut the tissue off with surgical scissors because I saw the instruments before the procedure. All I felt was pressure and tugging. No pain aside from the emotional grieving of having lost an intimate part of myself. I grieved for the loss the same way an amputee or breast cancer survivor would.
It still freaks me out some that he was cutting tissue off my body. It sounds like something out of a horror movie, doesn’t it? Just the concept was enough to freak me out. Yet through all of this I explained calmly and in clinical terms to Hubby what was going to happen. He was, again, not allowed in. I refused to expose him to it and I was determined that I would do my best to maintain a facade of normalcy.
I failed about half the time by this point. But I tried, by damn. I tried.
The most important thing to take away from this post is that if you have to endure debridment, it is NOT painful. It sounds scary but what’s scarier is what will happen if you do NOT have it done. So have it done and do something really nice for yourself afterward.
07.02.09
Nipples Or Not
For my regular readers, do you remember when I was vacillating about surgeons or even whether or not to HAVE another surgery? Well it’s that time again. This time I’m starting to research and contemplate nipple reconstruction.
I read some older articles that indicated that up to 40% of all nipple reconstructions fail. Most flatten out within 6 to 18 months. There is also a higher incident of infection and necrosis according to those older statistics.
THEN I talked to Dr. Elliott. He explained that those complications are not as frequent anymore. In the last two years or so surgical techniques have been greatly improved. He reassured me that usually those complications are due to poor blood supply. My tissue is healthy, according to him. He also went to lengths to reassure me that recovery time is going to be greatly reduced since this is an out patient procedure only dealing with topical tissue.
He also suggested that I research the Star Flap Nipple Reconstruction. The link shows the basic steps starting at Media 7 http://emedicine.medscape.com/article/1274411-media – star flap That’s the nipple flap reconstruction he wants to ue for me. He believes that specific type of flap reconstruction will work the best.
I really don’t want to have ANOTHER surgery so soon. I’d rather wait until this winter. So in the interrim, I’m going to get prosthetic nipples. Dr. Elliott is having his PA, Patti Bergley, look into it and see what she can find out for me. I’m expecting her to call today.
Talking to Dr. Elliott made me feel more comfortable about my outcome. I’m still tempted to get a second opinion when I go back to see Dr. Guy’s people in another week about the tissue growth isue on my back. I’d like to see what she has to say too.
The problem is now really the cost. Nipple reconstruction and any tweaking that needs to be done for aesthetics will cost us an additional $7000 on top of the $18000 we have already paid AND the $6000+ we still owe the hospital and the anesthesiologist. Nipple prosthetics on the other hand are only around $200 per pair for the really good silicone ones.
Really, I don’t think that it’s so much a matter of “if”. It is now a matter of “when”.
06.25.09
The Non-Infection Infection
I had my appointment with Dr. Guy’s people this morning at 11:15. There is good news afoot dear reader. According to Dr. Guy’s PA, the troublesome spot on my back is NOT infected. The white stuff is simply “flesh”. That IS a direct quote.
Unfortunately the flesh is inhibiting healing, so we’re back to doing wet-to-dry bandages. I have a follow up appointment in two weeks to check the progress. Hopefully by then the area will FINALLY be closed up.
For those not familiar with wet to dry bandages, I’ll explain. I believe I may have mentioned the profess in an earlier post but I’d hate for you to have to dig for it. When there is a fairly shallow wound in need of debreiding, the least painful ad least invasive way to do it and keep it relatively sterile is to use a wet-to-dry. Here, you take a piece of sterile gauze ad soak it thoroughly with saline. Then you pack it lightly into the wound so that it covers every bit of it, even into the corners. The wet then gets covered with dry gauze and taped. When it dries, the gauze adheres to the biological matter to be removed. When you pull it out to change it, it takes some of the matter with it. Then the process is repeated until the wound is clean.
Our bodies heal from the inside out. Following this process gives your body a clean bed from which to grow new flesh and eventually skin. It can be tedious and somewhat frustrating. Sometimes it only pulls off a little bit. I just keep focusing on the good news that it’s not infected.
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.
06.20.09
Under There
HA! Just made you say “Underwear”!
Seriously though folks, because of the relatively minor issues with slow healing on my back in a couple spots, I’m wearing camisoles either as my top or as an undershirt. It took me a while to find ones with half way decent support. I’ve found that shelf bras with wide eleastic bands do a pretty decent job. I found a bunch at Kohl’s on sale for $9.99 each. They have thin shoulder straps but the band is pretty wide so that sort of makes up for it.
I found two others at Macy’s with wide elastic shoulder straps and a wide band. I like those better as they tend to give better support. Unfortunately it’s summer in Florida and it is already reaching 99 degrees in the afternoons. I can only wear those once as undershirts before having to wash them. It IS nice just throwig on a cami and capris when I need to run out the door though.
I have all these pretty bras and panties and I still can’t wear any of them until these areas on my back are completely healed. Which brings me to a major complaint about Intimacy. I am STILL missing two pairs of panties. A couple weeks ago I got a call from a manager asking me if I had gotten everything. I let her know what I was still missing and that I had called leaving a message saying as much but never got a call back. She told me that she would investigate and call me back. I STILL have not heard from her.
I’m getting ticked off about this. They have such wonderful products but such hideous customer service that it’s really no longer worth it to shop there. For THAT kind of money per piece I expect MUCH better service. I will, of course, keep you all up to date about what happens. I WILL have my matching panties or someone will be dealing with an extraordinarilly pissed off Maria. That is NOT something anyone wants.
06.18.09
Numb: An Update
On 6/4/09 I wrote about rubbing a spot on my back raw with a new bra strap and causing some pretty major bruising. I simply couldn’t feel what was happening because the area closest to my spine is still insensate from the incisions on either side where the muscle was removed.
A couple days ago I started getting worried because the bruised area had sloughed off skin and the scabbed over area was turning an odd shade of yellow. Yesterday I noticed that it was tinged green. That’s ALWAYS a bad color for a wound. I am, of course, very paranoid about any kind of complications. So I had Ken take a photo, emailed the shot and called Dr. Elliott’s office to talk to one of the nurses.
After asking if I was running a fever or if there was a smell, she suggested that perhaps we were simply keeping it too moist. The bandage was being changed 1-2 times a day and copious Neosporin was applied. She also told us that we should be washing the area twice a day with antibacterial soap. This was news to me as had been previously told that it should be washed whenever I showered. Since I’m so inactive I don’t shower daily as it is simply too draining. I exhaust very easily.
This morning after covering the area with only non-stick gauze and no neosporin, it was back to where it had been previously. So this is a cautionary tale about keeping wounds TOO moist.
As for the numbness itself, it’s getting better. I do think that it’s probably going to take a few more months before my back is completely normal again though. Time will tell.
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.
06.09.09
Alone
I started this blog so that women going through what I have been through would not feel so alone. They would have someone to talk to who would understand in blazing Technicolor what it’s like to lose such an intimate part of yourself. Now I’m having those feelings and I don’t have anyone to talk to who understands.
Last night I started doing serious research on nipple reconstruction. I had no plans to do anything until late autumn but I like being prepared and knowing what I’m getting into. My findings showed that a high percentage of nipple reconstructions “fail” (read: Collapse) and a higher percentage develop complications like infection or necrosis.
My skin on my new breasts is SO delicate. It was like tissue paper a few weeks ago when the nurse took off the tapes and it just split in a couple small spots because of the pressure. Granted those were only topical. That tells me though since my skin is so delicate, I would have a higher probability of failure. I have considered nipple piercing with a small gauge bar to keep them erect, but that would proably just hasten the process of collapse.
My other alternative is a pair of custom made silicone nipple prosthetics. I’ve seen a couple websites and you really cannot tell the difference between the two nipples in a woman who has only had one side reconstructed. My problem here is the creator of the prosthetic has nothing to base the new prostheses on. There is also no one in the state of Florida that I have found so far that does custom nipple prostheses. That makes fitting much more difficult.
I don’t have any idea who to ask or where to go to find out if there IS someone more local to me. It is probably my perception, but Ken seems to be avoiding talking about it with me. He does that when he has no idea how to help. And so, I’m feeling very much alone.
Couple that with the realization that no matter what I do, I will never be the same and you’ve got a big nasty cauldron of bubbling emotions ready to spew forth and broil the crap out of some poor innocent bystander. I’ve already stuffed the dog out in the back yard because he was barking too much. Who’s next?
I’m having a bad day. Three days in a row of excessive activity has put me to the point that I had to take a 1/2 a Darvocet on top of it all. This is the first time in two weeks that I had to drag out the BIG pain meds. I know I overdid it but it still feels like a setback. But then, I’m already in bad shape as it is.
For the first time writing this blog, I feel vulnerable. As if I’ve said too much. There will probably be a Podcaster party at DragonCon again this year and I had planned to possibly show off the new Girls. For the first time in a LONG time I’m afraid of what people will think if they read this and then see me at D*C.
05.28.09
Six Weeks
There’s so much to talk about that I don’t know where to begin. Thursday May 27 will be six weeks since my surgery. Everything is looking good. The small opening on my back has scabbed over and is getting smaller every day. The other areas are all looking good. There is still the red spot on my right breast that hasn’t changed and there is still very minor bruising on the left. None of that is a reason for concern. I just find it odd that those things are persisting.
As requested by Dr. Elliott, I showered tonight, washed all the incision sites and re-taped them. I’m still not exactly certain why he wanted those re taped. He IS the expert here though so we deferred to his knowledge. My guess is that he still wants to keep the scarring to a minimum and that’s what the tape does. It keeps the scars flat and prevents them from becoming keloid scars (http://www.medicinenet.com/keloid/article.htm).
Something I noticed after my shower is that the skin on my back is still somewhat tight. It isn’t nearly as bad as it was six weeks ago when I felt like I was bound in a corset. It still feels like there is tape or some kind of light binding even when there isn’t though. I’ve also noticed that in a good portion of my back I still have absolutely no feeling. The only reason I know that I am touching skin is because my fingertips feel skin. I don’t even feel pressure in some places.
My armpits are almost as bad, though there is a little bit of feeling there. My left arm is almost completely back to normal as far as mobility goes. It’s still a bit sore, but it’s much better. The range of motion in my right arm is still limited. I still cannot straighten it directly next to my head. I CAN hold it at about a 60 degree angle though. I think perhaps I need to start working on stretching it. I may start a VERY light exercise routine of stretching to start increasing my range of motion. Before I do that though I’m going to call Dr. Elliott’s office and ask what they think first. No point in messing myself up if he says no. I’m all about avoiding the messing myself up bit.
Speaking of…I had another flashback tonight after I got out of the shower. It’s been a few weeks since the last time. I’m glad those horrific moments are getting fewer and farther between. I’m not thoroughly convinced that I may not be suffering in some small way from post traumatic stress disorder. PTSD isn’t just something that combat troops may have to deal with. Anyone who has been in a long term life threatening situation, whether that’s combat related, health related or even related to a rape, can develop PTSD. Flashbacks are one of those symptoms. For me, hell for anyone it’s completely terrifying to “see” incisions tear open like they did before. That was the first episode in a few weeks though. So that’s getting much better, too.
I’m starting to go out more frequently too. Before we left for my one month checkup I tried to get a hair appointment with my regular stylist because my roots were hideoulsy long. Unfortunately she couldn’t fit me in. So, silly me, I found someone else on the Pravana website and she squeezed me in. I say silly me because I actually expected her to do a good job since she claims she teaches at Brevard Community College in Cocoa. I even told her that for the dye to take properly, my roots have to be at least a gold color.
She screwed up. She lightened them to a medium brown and then tried to dye over that. My roots HIDEOUS. It looked like someone had tried to just dye over them. She promised that she would fix it for free. So against my better judgement I went back today. Somehow she managed to screw it up again. She DID manage to lighten the roots but not to the right shade because now they have an ORANGE tint to them!! I am NEVER going back to her again. I don’t care HOW desperate I am.
Now I have to wait at least a week before I can make an appointment with LeAnn at Belleza in Rockledge. I’m just going to have to call her, explain what happened and see how soon she wants to see me.
The day wasn’t a total loss though. After the stylist was done, Ken and I went out to Norman’s Raw Bar and Grill in Cocoa Village for lunch. While we were there we recorded the first episode of our food podcast “The Chipped Plate Chronicles”. YAY!!
I’m looking forward to Friday. I REALLY want to go see the new Pixar movie “Up”. It looks like it’s going to be absolutely fantastic! The reviews on www.rottentomatoes.com are phenomenal. I’ve also seen all the previews so I’m excited about it.
We have also planned that for our weekly outing to Disney, I am going to try to walk from the car in the Minnie parking lot (Yes, we know a secret) to the gift shop where they rent the wheelchairs. I think I could make it into the park, but by the time I got down to Casey’s, I’d have to have a cast member bring me a chair.
In the next couple days I’m going to release a post called “The Adjustment” that is going to cover more of my mental, physical and emotional adjustments and how I handled them. And how I’m STILL handling some of them so stay tuned!
