I’m taking a break from re-telling my story for a few episodes. Instead, today I’ll be talking about nerve pains.

Perhaps I’m stating the obvious, but that’s my job. With surgery, there will invariably be nerve damage. Some of it can be permanent. What it really seems to come down to is individual recovery.

As we’ve seen, recovery is a very individual process. Some people recover faster, others, more slowly. There are also different aspects to recovery. Today I’ll be discussing my experience with nerve recovery.

Over the last two – three months I have been gaining more sensitivity in areas that had previously been insensate (aka numb). Not all of it has been a pleasant surprise.  Over the last couple weeks I have been broadsided a number of times by nerve pain. In the past, that has consisted of a thin, bright pain as though I were being stabbed by long, thin needles.

Recently though, that pain feels much more broad or thick, covering a wider area. It feels like someone is driving a railroad spike into me.

Why does this happen? When nerve tissue in the peripheral nervous system (PNS) is damaged or severed as in during surgery, it DOES regrow. According to this article (http://en.wikipedia.org/wiki/Neuroregeneration) on nerve regeneration, small nerves can regrow at a rate of 2mm per day while larger can grow as much as 5 mm per day.

It is my understanding that the zappy/stabby pain is caused either by nerve damage or nerve regeneration. Or regeneration of a damaged nerve. I don’t have a definite answer. This seems to be as subjective as “recovery”. In the end, it seems only time will tell how much sensitivity my body will have.

Two weeks after the repair surgery I noticed that the stitches on the left side right above the open area were starting to come undone.

No. I’m not kidding. Nor am I exaggerating.  The stitches slowly began to unravel. They called it dehiscence. My research implies that is when the edges of the wound separate. What happened here, however was that the catgut, nylon or whatever it is that compriesed the sitches came apart and became more and more lose until the catgut or nylon was poking out and the edges of the wound was beginning to come apart.

And I thought I was horrified before?? HA! On top of that, I was downright pissed off at the Hack In Question because the fucker was on vacation. AGAIN! Oh and you think THAT’S a trip, try this one on for size: If you are under the care of a plastic surgeon in Florida, no other plastic surgeon will even LOOK at you!!

When the stitches started to loosen I was told that no one could see me at the HiQ’s office because he wasn’t there. So I called around to local plastic surgeons. I actually got into the office of one of the locals only to be told that I couldn’t be seen.

So I went home and the stitches continued to slowly unravel. As they lostened more, the skin pulled against them harder and I began unravelling faster. And STILL the Hack was out of touch. His office couldn’t or wouldn’t do anything for me. So finally when I was about 1/3 of the way undone I went to the emergency room. It was the only place that was left as far as I could tell.

I’ll talk about that adventure tomorrow. Unfortunately I don’t have it in me to do more than short burts.

After the second surgery there was actually a brief time when I thought that everything might be alright after all.

I should have known better.

I don’t know HOW I should have known better, unless past experience told me that the HiQ had no real idea what he was doing and the man was/is a menace and a disgrace to the medical profession.

I had just hoped that the worst was over.

And for a little while everything WAS okay. I actually had a period of about 12 days when everything looked like it was going to work out. Sure I was going to need one more surgery but at least I didn’t have to deal with the necrosis. I just changed the gauze over the surgical tubing drains and changed dressings like I was told.

Little did I know what was ahead of me.

I forgot to include something in yesterday’s post. Dr. Elliott had mentioned that he wanted to make sure that my breast tissue has become softer. For the first few weeks right after surgery, my new boobies were really hard and stiff. They were actually very hard. It reminded me of how hard my breasts were after the initial implant surgery.

I pointed out a place across the top of my left breast that, to me, felt harder that the rest of the breast tissue. After gently prodding at it a bit in examination Dr. Elliott explained that the harder area is the top of the muscle flap. He also explained that in comparison to what HE meant my hard it was actually very soft and pliant.

Something that I found to be extremely bizarre is that where I thought had keloid scarring, upon examination, appeared to have nothing of the sort. I am chalking this up to a slightly poor fitting Caique bra from Lane Bryant. It is just a little too small and it makes the scar line feel a little lumpy after a whole day of wearing that type of bra.

That’s one more reason to have a proper bra fitting done. Even if you think it’s been done properly, sometimes it hasn’t. Even though their customer service is really, REALLY bad,

Dr. Elliott is EXTREMELY pleased with how well the Twins are doing. He’s thrilled with how much they’ve softened and how well the scars are fading. He’s also pleased with how my back looks.

While he was looking and “groping” (forgive me Dr. Elliott, I don’t know what else to call it when you check to see how they feel) we talked about the things I was curious about. First, I found out the reason my back has that plasticky feeling like someone set down a layer of plastic wrap across a wide section of my back.

The reason for that is that he basically disected my back, probably doing more surgical maneuvering back there than in my chest. The crackly feeling is where scar tissue has formed in kind of a sheet. It will probably take another six months or so for that to release. He gave the same prognosis for the numb areas, although those could take even longer.

We also talked about how subjective the term “recovery” is. You “recover” in the recovery room. You “recover” in the hospital. You “recover” after the surgery and that can take over a year dependent on which aspect of healing we’re talking about. For instance it took me about six months to get my endurance level back to where it was. Some people take more time. Others take less.

It’s subjective.

We also discussed nipple reconstruction. I told him it probably wouldn’t be until this time next year. He said it didn’t matter. We could do it tomorrow, next week or five years from now. Personally *I* was just relieved that he wasn’t planning to retire any time soon.

Another thing we touched on was doing a breast lift. His concern is that there wouldn’t be much point to it because as heavy as the Twins are, they would end up right back where they are in no time at all. I would have to lose at least 30 pounds before it would become feasible.

My big issue with that is around that point the Twins will start getting smaller. As I’ve written before, to watch them shrink away is like watching my original breasts rot away. I just can’t handle that right now. I just can’t. As i sit here typing I can feel the panic rising and the tears filling my eyes. I CAN’T lose them again.

Okay, okay, I know logically that I’m not losing them. They’re a part of me and I love them dearly. I’m just SO not ready for that. And for the first time in my life I’m content to weigh 218.

We also discussed the two little places on my sides that look like little handles. he called them puckers I think. (Dr. Elliott, if you read this please leave a comment and correct my verbage). He said they were normal and occurred as part of the surgery. We could do a little lipo to lessen them but to tuck the skin would require another incision. Dr. Elliott didn’t seem very keen on another couple of incisions on me and I’m really quite okay with that. He explained that when you do the tummy tuck type breast reconstruction you get the same thing at the hip bone area.

Dr. Elliott made a point of mentioning that he was SO happy we had gone with the latissimus flap reconstruction rather than the tummy tuck. We both had been extremely concerned about possible complications. The tummy tuck procedure simply carries more risk and more risk was the LAST thing I needed.

So all in all the Twins are doing great. He wants to see me again Aprilish for my one year check up. In the mean time I REALLY hope that he checks in. He seemed really interested in my blogs.

And in case I haven’t said it enough, he’s an amazing doctor. Every woman who has to go through reconstruction for ANY reason should go see Dr. Elliott at Atlanta Plastic Surgery (http://www.atlplastic.com).

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.

As my regular readers know I developed necrosis two weeks after the October 2nd breast augmentation and lift surgery in 2007. After several weeks of Hell I was scheduled for a second surgery on November 2. This surgery was for the purposes of removing the implants and the remaining necrotic tissue. We showed up in the afternoon at the surgical center – which we had to pay the fee for – I was prepped and before I knew it, part two of my nightmare had begun.

When I was able I looked at what had been done. It seemed, in retrospect, Frankenstinian. The line of vertical sutures looked like someone had whip stitched the skin together. I also found out that, on the left side, there had been a half inch spot left open.

I also found out that over  300 ccs of serous fluid had built up in each pocket. The implants were both intact. That explained the pressure and the bubble under my flesh. Fortunately this time the HiQ put in what passed for really crappy drains. He had inserted open-ended surgical tubing. The outer ends were covered in gauze to absorb the leaking serous fluid that my body produced. Compared to the closed-system drains I had after my reconstruction, these things were positively primitive.

I was also an A cup now down from a DD cup and before that a C cup. This wasn’t nesecarilly a bad thing. I finally had the ski slope breast shape I had been after from the beginning. By ski slope I mean the breasts that are heavy and rounded on the bottom and on the top the breast gently slopes down to be capped by a pert, rosy nipple.

I was just missing the nipple.

The HiQ assured me that after i had healed, we could do reconstruction. At this point I was already starting to have my doubts. But I’ll talk more about that later.

For those of you joining me from NaNoBloMo and reading my blog for the first time, please go read the first post for more information about what BoobCast is all about.

While I was doing the wet to dry bandages before the debridment, I frequently felt like I was a zombie. No, I didn’t want to eat brains, though I DID want to severely damage the HiQ.

***WARNING! GRAPHIC CONTENT AHEAD***

No what I mean is that when I would peel off the wet to dry dressing and pull away bits of dead flesh, I couldn’t help but feel like I was, at least in part, an undead zombie. Here I was dropping bits of flesh. And that’s what zombies do…walk around, eat people and drop bits of their body.

Instead of eating people, I felt like this situation was eating me alive. And not just in the literal sense. I began losing myself to this situation. I WAS a bouncy, vibrant, spur-of-the-moment type of person before I became Zombie Maria.

It has only been in the last month or two that I’ve come back to myself. I’m not there yet. I still shamble a bit, though there are no brain cravings. And unfortunately I still haven’t gottten past the point of wishing the HiQ ill. I really couldn’t actually do anything myself. I’m not that kind of person. But you can damn betcha that I wouldn’t be feeling bad if he were to accidentally get his hands crushed.

The human memory is an odd creature. Or at least mine is. I have been trying to remember incidents from the first four or five weeks after the initial lift and implant insertion surgery. I’ll try to zero in on that time and then my mind will slip sideways as though the memories had a silicone shield. Everything just slides right off. Non-stick memories.

I’m guessing this happens because I tried so hard to repress and not think about what was happening WHILE it was happening. I just dealt with one second at a time, did what I had to do and cried about it afterward.  I was on what amounts to auto pilot. Either that or I detached and focused on the anatomical details. Although that really started more after the second surgery.

I wonder how much of this is a coping mechanism. Avoidance used to be a major part of my modus operandi. From what I learned when I was (briefly) a psych major, avoidance isn’t considered a healthy way of coping. Though I’m not so sure I WAS avoiding. I was changing the wet to dry dressings twice daily and going to my regularly scheduled doctor appointments with the HiQ.

I have to wonder how clearly people remember incidents of severe trauma. Does our brain initiate a response that allows us to be protected from the harshness of those memories? Is it some sort of conscious mechanism in which we tell ourselves that “this gets filed back here and we’re not going to remember this any more”. Rather like sticking our fingers in our ears and yelling “LALALALALALA I CAN’T HEAR YOU LALALALALALA!!”

***WARNING – VIVID DESCRIPTION AHEAD***

And then…sometimes I get some vivid memories back. Like one of the times I was pulling off one of the wet to drys and a big chunk of flesh the size of a quarter came away with the necrotic tissue and I felt like Imhotep from “The Mummy”. Or a Zombie.

I actually spent a moment or two trying to put it back in the spot. You know…like when you’re a little kid and you break your favorite toy. You try to put it back together and it won’t go but you just can’t figure out why it won’t go back together.

Yeah, I think I was a little insane for a while.

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.