Post – OP appointment news

Now for a more medical side of things 🙂

I had my first post -op appointment with Dr. Lynch (Plastic Surgeon, handling my reconstruction) on Thursday July 7th.  It was a good appointment.  Shawn was able to go along, which wouldn’t have happened if my surgery had been on the 6th as originally planned (blessing in disguise ;).  Everything is healing correctly, the fluids from my JP drains were low enough in two of them to go ahead and remove those two.  So drain 1 and 3 were removed….that’s a really weird sensation.  The JP Drains consist of two tubes of two – three feet of length each come out of my sides just about 2 inches above my lowest rib and hang down to just below my waist with a bulb at the end of each which I coil and carry in two pouches on a belt.  For those of you Star Trek fans (I have felt a bit like I was being assimilated by The Borg)  They appear to be just kind of hanging there loosely, tied to me by stitch thread, I often worry about accidentally pulling them out.  Dr. Lynch assured me before and after the surgery that would be pretty much impossible.  I now know why.  When he was ready to take the right one out, he said “Okay get ready this isn’t going to hurt, but it’s going to feel really weird.”.  I said, “Okay, I’m ready, no biggie.”  He kind of snickered and said, “Just wait, its weird.”  He then pulled about a foot of tubing out of my side, and I felt it slide from near my collarbone all the way through to the hole in my side.  And yes, I blurted out, “Wow, that was really weird”.  Then laughed at the shudder I saw Shawn make.  I wasn’t watching the removal, he was.  It did not hurt, and I didn’t expect it to, seems I’m still mostly numb across most of my chest.  But I felt almost every bit of that slide.  Weirdest sensation ever, maybe even topping the first movements of my babies in my belly.  I found out later that Shawn was shuddering about what followed the end of the tubing out…a bit of bloody stringy fibrous tissue.  Dr. Lynch said that was normal, it was kind of like the clotting that a bloody nose will do.  The removal of the drain from the left side wasn’t as adventurous, I am still extremely numb due to the axillary (armpit) tissue being removed from that side, and that was where drain 3 was located.  So yeah, there is plenty of length to keep them from just falling out accidentally.  Dr. Lynch then put some gauze and tape on the two open holes and said they might ooze a bit for a couple of days, but would heal up fairly quickly.  They were closed up by Saturday, and seem to be totally healed over as of today.  I still have two drains, 2 and 4.  Dr. Lynch expects to be able to take them out this coming Thursday, at my next appointment.

We talked a bit about the schedule for expander injections. As I mentioned in a previous post, they only put 100 cc in at the time of surgery, due to the lesser amount of skin on my left side.  He decided to wait until my next appointment before putting anymore in my expanders.  He wanted that skin to continue to regain sensation (meaning my nerve endings and other tissues were reconnecting naturally) for another week.  I believe he said he plans to put another 150-200 cc of expander fluid in at the next appointment this Thursday.  How do they do that you may ask?  Well, its similar to my PortACath for my infusions.  There is a special valve on the expander that allows them to inject fluid directly into the expander “bag” via needle and syringe without introducing anything else into the system.

He talked over a couple of things with us about movement and increased my weight restriction to 5-10 lbs.  He also said that I need to go ahead and start doing the post surgical exercises to keep/increase mobility in both of my arms and shoulders.  I am almost back to normal with my right arm, but my left (Lymphadenectomy arm) is a bit stiffer and I am having to remember to extend my elbow all the way out frequently as those tendons seem to be extra tight right now.   He still doesn’t want me “reaching” for things above my head but to do the stretches that will hopefully get me there by the next appointment.  I can do mild housework now.  I cannot lift anything heavy, but have been given the okay to push a laundry basket around with my foot 😉  Still no driving for me, so Julia continues to be my chauffeur, which we are enjoying immensely.

This morning Julia drove me to my post-op appointment with Dr. Rogers (my Breast Cancer Surgeon, performed the Mastectomies and Lymphadenectomy) at Baptist Health in Lexington.  The parking garage was an adventure as always, a first for Julia.  As I suspected this appointment was a super quick and easy one.  Dr. Rogers asked how I felt, when my next appointment with Dr. Lynch would be and what info I had been given from that side of things, took a look at the incisions, said they were healing so well he didn’t even need to do a palpable exam.  He then told me that all the labs came back perfect.  I said, “Great!  Now what does that mean?”  At the exact same time that he said, “So do you want to know what all that means?”  We all laughed a bit and then he explained that all the labs had come back benign, no signs of cancer in any of them.  The chemo had killed all that was there, they were able to get the desired margins of good tissue to clean out all the “dead” cancerous tissue, including the lymph nodes.  He mentioned again that they had taken 7 nodes out just to be sure that they had that margin of safety above and beyond the 5 that had “lit up” in my PET scan way back in January.  I then asked if that meant I would get to skip out of Radiation Therapy, but as I already knew that was a really a question for Dr. Ari.  He checked to be sure I had an appointment with him in the next couple of weeks (27th), and said that all the lab results were shared with Ari and Lynch as well and they would decide about the next step in treatment. Dr. Rogers then said, “Okay well that’s about all I do for you, except for a check-up in a year”.  I told him I appreciated his work and help with my care, that I was sad that we wouldn’t meet again for a year, but glad that I had one less doctor to see.  We had a good laugh, he understood.  Julia and I then gathered our things and headed back out of the office, less than 30 minutes after we had arrived.  That was a great feeling, almost carefree.  We opted to take the stairs back to the car on the 5th level from the 2nd.

So, good news from the docs all around.  And…I made it back to town soon enough to go to the library with my kiddos today, in a cute little outfit that Julia says makes me look like a teenager :).  Back to my old confident self and with a bright outlook from slightly past the mid-point of this cancer journey.

Missing my hubby tonight though, love ya, babe!  You’re amazing and doing what you need to do for our family at this time!

And tomorrow, we venture back into the world of “normal routines” with slight adjustments, as Grandma Jeffries heads back to her home and I step in to help Julia be the Momma for a bit longer while I still get my naps and a chauffer.  Thank you to both Grandma Beaver and Grandma Jeffries for the awesome 2 weeks you have given our boys!

 

…continued

I finally reached my hospital room around 5pm, Shawn met me halfway down the hallway I believe, or maybe in the room, still a little hazy about that part.  He hadn’t eaten since the bagel he had for breakfast, afraid that if he got up to go get something for lunch that he would miss the doctor’s reports during my surgeries.  Dr. Lynch had given him a report just after completing surgery so he knew I was okay and that I was cleared to eat anything I wanted “no dietary restrictions”, as soon as I made it to my room.  My parents were on their way back towards the hospital from Lawrenceburg around that time (3pm-ish) so they offered to pick up some food.  Subway was the order Shawn put in.  The nurses on my floor had requested a dinner be brought up to my room as well.  We figured we could share that until my parents made it back.  After several requests from the nurses, the dinner tray still never showed up, so we just had Subway around 6pm.  Life that evening was kind of a flurry of nurses with meds and nurses aides with blood pressure cuffs, and draining my JP drains, and me getting up to pee (with my pet IV stand in-tow each time), and nurses aides coming to take stats on the amount of urine and frequency.  I was up and about alot to the restroom and back, still receiving IV fluids and drinking lots of liquids due to that good ole cotton-mouth one gets from anesthesia.  The nurse would come in every couple hours and check my pain levels and see if I needed anything.  The later in the evening it was the higher my levels got, my PecBloc was wearing off as well as the other pain meds I was given.  It really felt more like a really sore muscle than actual stabbing pains.  I would usually tell them that my level was about a 3-4, Shawn would then pipe in, “Its probably more a 5-6, she always says lower than what it really is”.   I guess I do…didn’t realize I did that until then ;).  I wasn’t real pleased with the efficiency of most of the nursing staff on the floor.  Out of the 10 nurses and aides I had during those two shifts only two stood out as extremely exemplary.  I really hated to say that, I have been in several hospitals through the years and as you can tell from my opinion of the recovery room staff, I recognize a good team when I see one.  These nurses and aides weren’t.  They would get aggravated with each other, take too long to come back with things they had been asked to bring by from another staff member, not record things when they did come in, etc.  I really felt bad about it, but I was so ready to go home that I really didn’t mind being almost pushed out the door at 10:30am the very next day.  I thanked the nurses and staff who were good to me and tried to help those that seemed a bit more out of sorts or awkward at their tasks.  But, yeah, that wasn’t my best hospital stay. And before you say “oh maybe they were too busy”, there were 6 nurses assigned to 5 patients, with 4 assistants/aides.  Maybe all the good ones end up in Recovery or Maternity, who knows.  I did have a gorgeous view out my windows though, straight across to the Lexington skyline.  The cleaning staff were very kind, happy, and efficient as well.  I liked my chats with them too.  And my two favorite nurses actually came to see me off, thanking me for “being a patient that actually wants to get better”.  And for being so nice and cheerful.

After a decent night of sleep, only being interrupted a couple times for meds and stats, I was awakened by Dr. Lynch at 6:55am.  Checking my incisions, the amount of liquids from my JP drains, loosening the dressings and ace-bandages around my chest, and then giving me some specifics about how the surgery went and what to expect over the next couple of days.  He had decided to put 4 JP drains in, one close to my collarbone on each side, and another lower on each of my sides.  All 4 just under the muscles leading away from the “hole” left by the tissue that had been removed.  The body fills holes like that with liquid, that is a bad thing to be left as is, so drains are the solution.  He also explained that my expanders had been placed as well, with the extra skin pocket to hold them up in place.  They only put 100 cc of fluid into the expanders at this time, due to more skin having to be removed from my left breast than expected.  I would have the 4 drains in until the follow up appointment the next Thursday.  I would need to drain them as shown by the nurses at least twice a day, into measuring cups, and record the amounts.  The liquid would change from a reddish color to a pinkish orange color over the next few days and whichever drains had reduced to less than 10 ml per emptying would be able to be removed at the follow-up appointment.  I was to continue taking my Celebrex (usually prescribed for arthritis patients for aches and sore muscles) alternating every couple hours with Tylenol throughout the day for the next couple of days and take my Valium (for anxiety and muscle spasms) and Oxycodone at night to help my muscles relax while I slept.  I needed to sleep on my back, propped up with my arms alongside my body as well, not below, to help with circulation.  I needed to get up and walk at least 30 minutes out of each day, get outside for the walk if I could have a buddy along, to keep from having any blood clots.  He wanted me to move my arms around and away from my sides as much as possible, but only in slow stretching motions and never above my head until after my follow-up appointment.  I shouldn’t drive for at least 3 weeks, more for avoiding sudden arm movements than about meds.

After Dr. Lynch left, Dr. Rogers came in a few minutes later.  He gave me a few details on how my surgery went and as I said before commended me on being such a good patient.  He had given Shawn more details the day before about having had to remove more axillary tissue than planned and there being more breast tissue to remove than they originally thought as well.  The calcified cells (now benign breast cancer cells) were located a lot closer to the skin than was originally assumed.  They warned us about this in some of my mammograms and the MRI, thus our worries about a lumpectomy leaving me severely disfigured in that area.  Our concerns proved to be true, it would not have been a small, simple lumpectomy.  He also told Shawn that the lymph nodes were not easily recognizable at this point, having been subjected to chemo.  So they took out the equivalent to a “bowl full of jelly” around the previously mapped area, with a margin of “good” tissue surrounding it.  The tissue that was removed from my “healthy” breast was also examined and made sure of the safe perimeters of healthy tissue.  All three sections of tissue were sent off to the labs to be examined in more detail, to be sure that all safe perimeters existed and to be sure that all cancerous cells were now benign.

After Dr. Rogers left there was a bit of down time where I was able to change out of my hospital gown, get my IV tubing removed, and change into my own cute PJs and robe that I brought along expecting to be lunch time or later leaving that day.  Dr. Ari popped in while I was eating my breakfast, just to say Hi and ask how I was feeling (again, awesome Drs., he had no responsibility to do anything of the sort for me on this day for this procedure).  Then the nurse popped in and said, okay lets get your checkout paperwork done…Um, okay?  What time exactly were they expecting me to be picked up?  It was only 9am, and Shawn was probably just now waking up at home (45 minutes away), he had stayed with me until 11:30pm the night before and didn’t get home til after midnight.  I mentioned all this to her, she said it wasn’t a biggie, I could stay until he got here, but I could also leave anytime I wanted to.  So, while she gathered my going home packet, I gave Shawn a quick call.  He was already awake and was about to hop in the shower, shewwww.  And as you know, I was home by 11:30am.

I didn’t want to stay home alone while he got my prescriptions filled, so I rode along, I was feeling good enough that we popped into a local fireworks stand and looked around for a bit, then grabbed lunch and headed home for the rest of the day.  I ate lunch, fell asleep on the couch for awhile, then woke up needed my ibuprofen (replaced Celebrex, because of insurance).  A friend brought by some dinner for us about that time too, so we ate dinner, then afterwards my meds were in effect again, and I felt like going for a slow walk around the block.  I was a bit tired when we got back but it sure felt good, and Shawn didn’t let me over do it.

Sleeping that night was kinda awkward and lonesome, I’m used to falling asleep on my side and really close to Shawn.  Yeah, neither of those were possible.  But I did take my prescribed meds and woke up the next morning just a bit sore, ready for my next dose of ibuprofen, but able to move around.  This was when I realized that my c-sections were harder on my body initially than this surgery.  This one, I could use my legs and tummy muscles to move myself around, to get up, to sit down, to roll over, to shift.  This wasn’t too bad.  I sure got tired out easy though.

The first couple of days I couldn’t sleep past 8am, my chest and shoulders and arms were just sore, like I’d been lifting weights or something.  So I would get up, take my ibuprofen get some breakfast and do a few little things.  Then spend a few hours on the couch, getting up from time to time to get a drink or use the restroom or just piddle around.  One morning Julia and I went for a short walk around the block.  The next day was even better less “stiff muscle” feeling and not as easily exhausted.  The next day, I decided I wanted to try for a walk around the big park here in Lburg…1.3 miles.  It was easier than I thought it was going to be, didn’t even get winded going up the hill, but I sure needed a nap that afternoon.  I have been doing really well.  I have been behaving, not overdoing it, my helpers and nursemaids have been making sure I don’t forget not to lift things and not to reach over my head.  All in all I am doing grand.  Thursday morning, I got two of my 4 JP drains removed, YES!  Today, my right arm and chest muscle are barely even sore.  I have been able to shower since Sunday, its a bit awkward still but nice to be cleaner and have that freedom.

I am so grateful that all that insurance crap happened now, because it gave Shawn a whole extra week to be here for my recovery, to be here for my first follow-up, and to be HERE for me.  Now, we send him off tomorrow morning for his hardest part so far, being away from the whole family for a week or more at a time for 7 weeks.