I know you all are used to lots of details from me, but in the interest of getting the information out in a semi-timely manner, I’m going to keep it short.
All good things from my 2nd appointment at Vanderbilt Breast Center!
What you want more? LOL, okay.
The Imaging Appointment –
I went a bit stressed over having to go through an MRI. I’ve had one before and it’s not the most wonderful imaging experience I’ve had, and then there was the reading afterwards (yeah, therapy-worthy issues there). Well, #1 good thing of that day: it wasn’t an MRI after all, just a CT Scan with IV contrast. Cool. I’ve done one of those recently and that’s super easy. The staff at the University of Vanderbilt Hospital Imaging Center were amazing. Friendly and good at their jobs, too. Yay!
- non-medical related details
- That place is HUGE!!!! We were super early, so I drug Mom around several different ways. Also, at every turn we were met with all sorts of staff (doctors even) eager to help us find our destination. We must have looked like lost tourists, lol. I’ve become pretty good at finding my way around hospitals and medical centers as of late, this was a new challenge.
- The Hospital is literally connected to the University Campus by a courtyard, and not in the way University of Kentucky is set up. Doctors with groups of students wander in and out of the hospital and the research facilities, dorms, and classrooms for medical majors are right there! Yup, I’m in good hands.
New Patient Appointment with Dr. Braun, partner to Dr. Kent Higdon –
Going into this appointment I was nervous about my lack of weight loss, and the looming possibility that the Scan results would show something wrong with my blood vessels in my belly, both of which I feared would boot me out of being a candidate for the DIEP surgery that I want to pursue. Dr. Braun was running late coming from the downtown surgical center to the Breast Center where I see him at. The Scan results were not in yet, even though it was supposed to be, that’s why I had a 6:30am scan so that the results would be ready in plenty of time for Braun to review them and read them to me in the appointment. So, yeah I was a bit of a ball of nerves sitting in the exam room waiting and waiting. Dr. Braun arrived and as I heard him speaking to patients and staff in the halls, I felt a bit of ease settle over me. He sounds okay, so far. As he entered the exam room, with the Assistant in tow, he was just as he sounded. A very mild mannered man with just enough age to be experienced, and just enough kindness to have at least a bit of Dr. Lynch’s manner.
Dr. Braun then began our visit. He apologized if he seemed a bit unorganized he would be talking about things kind of out of order from his usual first visit, seems I had already had a consultation appointment with Dr. Higdon, during which we had already decided on surgeries options for me, and which I preferred. He then asked if I had any questions about anything Dr. Higdon had talked with me about. Out it came.
I stammered through my explanation that I hadn’t lost any weight since my last appointment 2 months ago. Explaining that Dr. Higdon said that I needed to commit to losing 20 lbs, and I have plateaued at 180, sometimes 179. I continued to explain that I know my increased activity of working on a farm and eating more veggies has helped though, because I have lost inches and FEEL better. Pants and shirts are fitting more loosely around my waist and belly areas. He anticipated my question, “You want to know if you are still considered a candidate if you aren’t losing the pounds?” I replied that that was my biggest worry. He then said, “It sounds like you are trading fat for muscle, which is a good thing. Let’s look at how close you were to the acceptable BMI limit.” I was only .2 over the limit of 36 BMI mentioned by Dr. Higdon. Dr. Braun explained that during the consultation visit Dr. Higdon asks women with a high BMI to plan to lose at least 20 lbs. If that person comes back for the first official exam visit and scans they know that patient is truly serious about this surgery and will then work to help them find a goal and routines that will help them lose the weight with a general date in mind. In my case, I am already exhibiting a return to healthier habits and am under the upper safety limit of 40 BMI, and close enough to being under the limit Drs. Higdon and Braun have set in their own practice of 36. I could have the surgery right now if I wanted to. I was so amazed by that! Dr. Braun snickered abit and then settled me down by asking if I wanted to schedule it now, with the suggestion to wait a couple of months until I hit my next plateau. He mentioned again his amazement and respect that I am doing farm work at this stage of my life. We talked more about how much of it is manual labor, and how much is in the heat, etc. We also talked about how long I expected to be working the farm job. I told him that I was glad he had asked that, because I would really like to continue to work until late October, early November (the end of Market season). I wouldn’t be able to do that if I had the surgery now. After chatting about more details, we decided it would be good to wait a full month after my last Market date, to let my weight “loss” level out. So, my surgery will be scheduled for late November – early December, with my next appointment for mapping and physical exam sometime mid-October. In the meantime, Dr. Braun’s office staff will get the ball rolling on insurance authorization for coverage at their facility. It can take up to 6 weeks for the approval to be received, better to get it moving now. Once the approval is received they will call me to schedule my October appointment AND my tentative surgery date!!!!
Here’s where the discussion ended up a bit out of order. I realized I hadn’t asked about the scans yet. So I asked, about how the scan results (whenever he received them) would impact my candidacy. He had not had a chance to review my scans yet, but he would be doing a physical exam in a few minutes that should give him sufficient observations on the condition of my skin, vessels, and nerves to confirm my candidacy. He felt confident that the Imaging department would have already notified them if there were any worries with the blood vessels, they do these scans for them a lot and know what they are looking for.
He then did a physical exam on my whole torso and my hip area as well. It was a bit disconcerting with a lot of pinches and pokes and lifting. After examining the irradiated tissues and my left arm tissues and my armpit area, he did a bit of a pinch test on my belly and abdominal skin and fat. The good color return was exactly what he was wanting to see. My c-section and hysterectomy incision areas and scars would not be in the way either. He asked about my size expectations as well, and agreed to work that in. I have plenty of tissue for my desired size (the same as I was before, maybe slightly bigger to compensate any weight loss I might have during the healing process). They will be removing all of the irradiated tissue, it’s just not returning to the softness and flexibility it should be for healthy skin. It is “cooked”. He commended me for how much mobility I have kept in my left arm, noting just how tightened the tissue and muscles are across my chest and into my armpit. He also confirmed that they will be removing my existing implant for sure and doing a bilateral DIEP.
When he had completed the exam and made notes in my folder, he asked if I have been given any information on how the actual surgery goes. I told him I was pretty sure Dr. Higdon had given us some stuff to read, but if he had something to give me I’d take it too. He also suggested that I spend the next couple of months doing online research and watching videos and getting used to everything from preparation for to recovery from the surgery. “Not the horror story ones, because we don’t do those at Vanderbilt. We have the experience and resources to have ironed out those wrinkles so well that people come to us to fix those types of complications from other surgeons. That being said, it’s not an easy one.” I had no misconceptions on that, but it was good to hear that last phrase come out of the Micro-surgeon’s mouth, too. There’s just something very comforting about the surgeon being open and upfront about how hard and involved things will be. Not just a sales-pitch. The surgery will take between 8-12 hours. Yeah, that was a shocker to me too. I will be in the hospital 3-4 days in a private ICU room for constant observation. I will come home with 4-6 drains. I will NEED to have a comfortable recliner at home to sleep in for at least the first week or two, maybe longer. The recliner was suggested on all the Mastectomy prep lists, I didn’t end up needing it then, but for this one its a must because of the belly/arm/chest combination. So I have a few months to save up the funds and do some major in-store “research” to find THE perfect recliner. I will not be able to do much for myself for the first few days after surgery, except go for slow walks. Then, light-duty for 4-6 weeks.
So yeah, its a big surgery, bigger than my mastectomy and reconstruction in 2016. But, I still feel that it’s right for me and it’s what I want to do. I’m not suffering from a severely post-chemo compromised immune system. I’m not suffering from radiation fatigue. And, I will not have the risk of my irradiated skin being too weak to handle healing correctly from surgery (it won’t be there anymore, my own healthier skin will be instead). All the research I’ve done says that its a much more physical and mentally healthy reconstruction when done by an extremely experienced micro-surgeon TEAM at a well prepared facility. I feel sure that I have found both at Vanderbilt. I may also have the option of Sensory Nerve Repair which may restore partial sensation in portions of my chest. It’s a procedure they can do while they are already in the process of reconstructing blood vessel connections and such. Both Drs. Braun and Higdon have done hundreds of them with this type of surgery. It’s just whether I want it done, and what condition my cut nerves are in. We will be discussing that more during my October visit. I’m not really sure how I feel about that yet. I’m nervous that rebuilding my nerve connections will leave nerve pain in place of numbness (Postoperative-Neuropathic Pain). I will be asking questions about that for sure!
Results of the CT Scan – All good blood flow, no obstructions or major scarring in the vessels or tissues to be used. One miniscule kidney stone. (What!?! I wonder how that’s going to go?)
Dr. Braun’s observations were correct, I’m all good to go!
Links to more info about this type of surgery:
Sensory Nerve Reconstruction: Restoring Breast Sensation During DIEP Flap after a Mastectomy
What to Expect After DIEP Surgery?
DiepCJourney – Foundation/Blog