11.02.09
Seven Month Checkup
Today I’m going to see Dr. Elliott for my seven month check up. Normally it would be six months but he cut me a little slack because life has been a bit insane lately with Ken’s new job, me taking over our business, school and general family issues.
I’m sure he’s going to say everything is okay. There are some things I want to cover with him though. First, a wide swath of my back still feels like it is covered in plastic wrap. I wish I had some other way to explain it. It just feels like a big square of my back has had a cracky plastic coating painted over the top. Or maybe like someone laid down wide strips of packing tape. I really hope he understands this analogy.
I also still have numb spots in places. The other night my right armpit itched abominably but I have no sensation in that area. You wanna talk weird? Try itching someplace that’s numb. THAT’LL throw your brain for a loop.
I also want to get his opinion on the small area of keloid scarring. Please see the entry on 9/30/09 for more about this topic. It’s not much but I think he ought to know.
I also need to tell him that we won’t be able to afford my nipple reconstruction surgery until around this time next year. Then I want to ask him what he thinks about the Japanese practice of inserting pearls under the skin for nipple protrusion. Unfortunately I cannot find a reference to that at the moment. As experienced as Dr. Elliott is though I’m sure he’s heard of it IF it’s something that is actually done.
Until recently about 2/3 of all nipple reconstructions failed. Dr. Elliott has gone to incredible lengths to reassure me that with current techniques that won’t happen. It IS normal for there to be some shrinkage though.
I’ll report more on this later.
10.28.09
The Reality of Malpractice Law Suits
In the third week after the first surgery I called two different malpractice lawyers. They both told me the same thing. In the state of Florida a plastic surgeon is only required to carry a minimum of $100,000 in malpractice insurance.
That amount would cover the investigative and legal fees and I would be left with very little. In all likelihood it would not be enough to pay for reconstructive surgery.
In the investigative part of the law suit they subpoena the records from the surgery. Once the records are subpoenaed, (or even before that) anyone can go in and change the records to indicate a more favorable position for the surgeon and the surgical team. So by the time the attorney gets them, there may be no evidence at all of malpractice.
It is also difficult to define what exactly constitutes malpractice. Who’s error was it? WAS there even an error?
Much later I spoke to a surgical nurse an another site who said that she thought, from the bruising I described, that something must have gone catastrophically wrong during surgery. But there wasn’t really a way to prove it.
So there you have it. Make sure you know what you’re getting into. Ask how much malpractice insurance your PS carries. You only get one body. Make sure it’s protected.
10.15.09
What Is The Sound Velcro Makes?
This is going to be a slightly more graphic than usual post about wet to dry dressings and what necrosis looks like as it develops. So those without strong stomachs are cautioned. I will do my best to inject humor into this as I go. Humor and my support system are really the only way I survived this in the first place.
That, and I rediscovered the analytical part of myself. I mentally separated myself from the situation at hand. I used the phrase “THE breasts” as opposed to “MY breasts” and I never looked at myself in the mirror. So I dissociated to some extent while I was changing the wet to dry bandages.
Initially I didn’t really understand HOW wet the gauze was supposed to be. I was told by the nurse that the gauze should be damp. *I* thought that meant it should be dripping just a little bit. After a couple days I noticed there was little to no progress with the wet to drys. Progress would mean the removal of dead tissue. I was pulling off the occasional fleck here and there but nothing meaningful.
Let me explain a bit more about wet to drys. Once the gauze has been dampened in sterile saline solution, it is laid flat in one or two layers over the area to be debrided. It is molded to the body part so when it dries it is a bit like plaster. A successful pull makes a soft sound akin to velcro being pulled from its fuzzy moorings.
When I went back in for the next check up a couple days later the HiQ complained that there was not enough progress. I explained what I had done and was given the moisture level corrections. It seems that instead of dripping slightly, the gauze should be just slightly damp. Previous to this I had done what is called “packing” where the area is kept moist with wet salined gauze. Thus my confusion, I suppose. We’ll go in to packing later when things have gotten REALLY bad.
Once I had been given better information I was sent home for a couple more days. I was also told that I should only be changing the wet to drys one to two times a day. I HAD been changing them 3-4 times because that was what I had done when I was packing. No one told me to do anything different as far as changing went. Isn’t it amazing how nothing changes when there is no communication?
With the new changes I was getting more dead tissue off. When I pulled off the dried gauze it was definitely pulling away the blackened tissue. The HiQ had me do that for about a week and a half. In that time I still forbade Ken to come in during bandage changes and showering. No one should have to be exposed to that.
I had started crying at least every other day at this point and I was really depressed for obvious reasons. Pulling bits of dead flesh off your own body tends to do that. I was angry because I couldn’t get a straight answer out of the HiQ. The man had all the bedside manner of Dr. Mengele. Which was pretty evident by the “don’t scream” comment when he was sewing cadaver skin onto me and telling me that it was an extremely expensive treatment.
Really folks that all I can manage for today. Come back tomorrow and I’ll tell you the Valium story.
10.06.09
Boob Squishies
To quote Dharma Freedom Filklestein Montgomery, “Mammogram!! It sounds like something that should be delivered, doesn’t it?”
It’s that time of year ladies. The time when we make our yearly appointments to have our breasts pressed into a thin, transparent form. None of us like to do it. It’s uncomfortable, awkward and a real inconvenience. And here’s where the lecture comes in.
Every woman I know makes excuses about why they can’t get it done. I’m here to tell you that there IS no excuse for disregarding your health. By NOT having a yearly mammogram after the age of 40 if ANY woman in your direct family has had breast cancer, you are potentially taking your life in your hands.
It’s National Breast Cancer Awareness Month. We all know someone (or knows someone who knows someone else) who has had breast cancer. Some women, like my two aunts and my mother, have come through it just fine and have been cancer free for decades.
Other women like my friend, let’s call her Hanna to protect her identity, aren’t so fortunate. Hanna developed breast cancer and opted for a natural treatment route. Unfortunately, it was ineffective and the cancer spread. Somehow, using something called Black Salve, she got rid of the tumor and she went into remission for about 5 years.
Unfortunately, she didn’t get the entire growth because it came back with a vengeance the second time. It spread into her arm rendering it useless. The cancer grew in such a way that the doctors would have had to remove her arm to remove the cancer. It wasn’t long before it spread throughout her body including her brain. She has had two brain surgeries. But there is just too much in too many places in her body. She is now in hospice and may not live to see this Christmas.
The bright spot is that she made it to her goal. She wanted to live long enough to see her daughter graduate from high school. She made that goal Her daughter graduated this past June.
So please ladies… Suck it up and deal. Get it done. It’s only once a year. MAKE time. It may just save your life.
09.30.09
Keloid Scars
I may I have covered this topic before but not as it applied to me, personally. I noticed something last night after I took off my bra. There is a two to three inch area on the underside of each of my new breasts that has some keloid scarring. These spots didn’t have tape on them consistently as they are furthest out towards my sides and the tape kept coming off there.
Imagine if skin could simmer like water and then be frozen in that state. That’s what keloid scars look like. Here’s a photo of keloid scars on someone’s chest.
Doctors do not understand exactly why keloids form in certain people or situations and not in others. Changes in the cellular signals that control growth and proliferation could be related to the process of keloid formation, but these changes have not yet been characterized scientifically.
The methods now available to treat keloids are:
- Cortisone injections (intralesional steroids): These are safe and not very painful. Injections are usually given once per month until the maximum benefit is obtained. Injections are safe (very little steroid gets into the bloodstream) and usually help flatten keloids; however, steroid injections can also make the flattened keloid redder by stimulating the formation of more superficial blood vessels. (These can be treated using a laser; see below.) The keloid may look better after treatment than it looked to start with, but even the best results leave a mark that looks and feels quite different from the surrounding skin.
- Surgery: This is risky, because cutting a keloid can trigger the formation of a similar or even larger keloid. Some surgeons achieve success by injecting steroids or applying pressure dressings to the wound site after cutting away the keloid. Radiation after surgical excision has also been used.
- Laser: The pulsed-dye laser can be effective at flattening keloids and making them look less red. Treatment is safe and not very painful, but several treatment sessions may be needed. These may be costly, since such treatments are not generally covered by insurance plans.
- Silicone sheets: This involves wearing a sheet of silicone gel on the affected area for several hours a day for weeks or months, which is hard to sustain. Results are variable. Some doctors claim similar success with compression dressings made from materials other than silicone.
- Cryotherapy: Freezing keloids with liquid nitrogen may flatten them but often darkens the site of treatment.
- Interferon: Interferons are proteins produced by the body’s immune systems that help fight off viruses, bacteria, and other challenges. In recent studies, injections of interferon have shown promise in reducing the size of keloids, though it’s not yet certain whether that effect will be lasting. Current research is underway using a variant of this method, applying topical imiquimod (Aldara), which stimulates the body to produce interferon.
- Fluorouracil: Injections of this chemotherapy agent, alone or together with steroids, have been used as well for treatment of keloids.
- Radiation: Some doctors have reported safe and effective use of radiation to treat keloids.
This is not a very common complication, but it can happen. There doesn’t seem to be a bias. It happens equally in men and women as well as all ethnicities.
08.15.09
The Surgery
I took all the vitamins, antibiotics, etc people at the HIQ’s office (Hack in Question) told me to take in the order I was supposed to take it. We made reservations for a hotel to stay in for a few days so that I wouldn’t have to ride back and forth to Melbourne from Orlando right after surgery.
In the intervening two weeks I have to admit to having had some doubts. I considered canceling the surgery on one occasion only to find out that we still would have owed all the money anyway PLUS a cancellation fee.
The big reason I was having so many doubts, I think, was that my Mom completely freaked out when I told her that I was getting a boob job. She reverted to “lecture” mode and preached at me about her really bad experiences. What I find odd now is that she didn’t give me ANY details at all about what had happened, presuming that I just knew or remembered.
I didn’t.
I was scheduled for 2pm on October 2nd 2007. HiQ asked me be at the Bougainvillea Clinique in Winter Park two hours before surgery. There was paperwork to fill out once I got there. Of course I hadn’t had anything to eat or drink since midnight because of the possibility of aspirating.
We got there early and the nice nurses in the office gave me the paperwork I still had to fill out. It was the standard pre-surgical paperwork: allergies, etc. So I got that done and began the long wait. I tried distracting myself with a magazine but I was still really nervous. Finally when I thought I was going to pop, a nurse called me back.
There were probably about 10 to 15 bays separated by curtains. Each one contained a wheeled gurney and monitoring equipment. I was given a bag for my street clothes and in exchange, I was given a hospital gown that I was told to leave open in front. I was also given a pair of surgical hose to put on. They help to prevent blood clots in the leg from what I’ve been told by both the staff there ad Dr. Elliott’s people.
Then the HiQ came to see me. He made a bunch of measurements and pen marks all over my chest. I asked if I could make a change in implant size to something smaller. He replied “Well you’d better not change your mind because I only brought the one set of implants”.
After the HiQ was done, the nurse came in, popped an IV in my arm and took my vitals. Of course my blood pressure was running a little high because of nerves but that was to be expected. Then she placed these odd sleeves on my legs over the hose. I’ll explain those in a few minutes.
After all that we waited some more. Ken kept my mind occupied so I wouldn’t freak out while we waited MUCH longer than we expected. We were told that the previous surgery was taking more time than expected. Finally the nurses came to wheel me in to surgery at about 3:30. I kissed Ken and told him I would see him soon.
Once in surgery the leg sleeves were hooked up to a machine that rhythmically pumped air into them. Their job was to keep blood flowing well in my legs. The compressions also reduced the possibility of developing blood clots. I was given an injection through the IV and within a matter of moments, I was out like the proverbial light.
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.
07.25.09
BoobCast In Real Life
A couple nights ago Ken and I were in the lobby bar of the Westin Hotel in Atlanta. We were celebrating his new job by having a couple glasses of wine while we caught up on work. Yeah, I know. Not much of a celebration. But it put me in the right place at the right time.
There were three people talking over drinks and the woman, who was already knee deep in one martini started to poke fun at us for sitting over in the corner typing away instead of socializing. So, not wanting to be TOTAL geeks, we put down the laptops and joined them for a couple rounds.
Of course as people are wont to do while being “socially lubricated”, the guy blurted out that the woman wanted bigger boobs. Yes. Out of the blue. For no apparent reason. Now me, already being slightly tipsy, I just kept quiet. But Ken popped up ad started talking about how I had problems with my own cosmetic surgery.
So I gave the brief, horrific version about loosing most of both my breasts because of the idiot doctor I had and his inability to recognize or deal with complications. I also explained all the things about implants that I’ve already talked about here.
She, however, wanting to make her point, said that she wanted to show me something. So she got up and stumbled over, almost falling on Ken, to kneel in front of me and show me the water balloon thingie in her wonder bra. This woman was a MILF (of 3) on par with Kate Hudson or Kate Beckinsdale. Every guy (and bi/lez woman) in the bar was watching her.
I proceeded to explain to her JUST how STUNNING she already was. I let her know that the guy she was with already loved her for who she was. He didn’t want her to get implants either. I let her know that she was an amazing, smart, beautiful, sexy woman just the way she was. What she NEEDED to do was to love herself the way he loved her. She needed to learn to accept that she already WAS beautiful and she didn’t need “improvements”.
She didn’t say anything but she gripped my wrists hard and stared into my eyes. I think I made a difference. At least I would like to hope that I did.
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.
07.08.09
The Check Up
This afternoon I’ve got an appointment with Dr. Guy, the local Uber plastic surgeon. She’ll be checking on the progress of the tissue overgrowth on my back in that one spot. According to Hubby, who can actually SEE what’s going on back there, it’s closing up FINALLY. I’m still going to hold off on wearing bras for a few more weeks though. Just to give that spot time to FULLY heal.
I’ve also found a way to make these shelf bra camis more supportive. There’s a bra-maker supply shop here (http://www.bramakerssupply.com) that has everything I need to replace these flimsy straps with wider ones. The elastic under the breasts is pretty wide already so i won’t have to replace that. All I have to do is hand dye the new shoulder straps to match and sew them in. VOILA! New, supportive cami shelf bras. Since I live in Florida, wearing two tops in the middle of summer is just too hot. So this solves both the problem of support and the heat issue. I’ll post pics when they’re done.
The *other* checking up thing I have to do is call Patti at Dr. Elliott’s office. She was supposed to call me about where I could get silicone prosthetic nipples locally. Since I don’t have an existing nipple to be cast and copied I may not have to see someone to be fitted. But then as large as the new Twins are, I may. I have NO idea ho that works really.
That’s one more thing I’ll have to report back on one I know something. I REALLY want to have the prosthetics in time for DragonCon. I’m still REALLY not in a head space for another surgery yet. Even if I COULD afford it right now, the last thing I’m looking forward to is being cut on more even if it IS just minor, in-patient surgery.
I’m afraid I can’t find any photos of the star flap nipple reconstruction. I did put up a link in an earlier post though. I’ll dig around and see what I can find and edit this post if I can find an appropriate image.
