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Monthly Archives: April 2009

Tunnels

I haven’t talked about the tunnels yet to the best of my recollection.

With the Latissimus Dorsi Flap breast reconstruction, the  surgeon takes part of your back muscle, along with the corresponding fat and skin, detaches one end from the connection near the spine and brings the entire mass around UNDER the skin to the chest. The tunnels are not small. They are about the width of a hand and a half.Which is MUCH larger than I thought they would be. It makes sense though when moving large volumes of tissue that the way to move it would have to be larger than what is being moved.

This explains why it feeels like someone is sawing away at my armpits with razor wire. The nerves are SO raw and sensative in the tunnel area that even minor movement can make them flare up.

The use of tunnels makes this type of reconstruction so much safer because one end of the muscle and tissue is left attached to the original blood supply. This steady blood supply greatly reduces the possibility of necrosis

 

The Journey Home

We just got home from Atlanta at 8pm. This ranks as one of the longest days I can remember next to being in labor with my sons. Fortunately the muscle relaxer has the tendency to knock my happy ass out. I slept in the car for about 4 hours of the 9 hour trip. The rest of the time I was listening to my favorite podcasts: either The Geologic Podcast with George Hrab, Scott Sigler’s “Contagious”, the finale of Mark Yoshimoto Nemkoff’s “Transister Rodeo”, or the latest book by Greg Crites that he deigned to put up in the Literary Lugwrench Clodcast.

Taking frequent breaks was the best possible thing I could have done. It hurts SO much worse without those walks even with the regular doses of Percocet and muscle relaxer (Methylcarbamol). The way my pain levels are hitting it looks like the Methyl is going to be my primary pain relief with a half a Percocet reserved for breakthrough pain.

The one time we stopped for a late breakfast, I talked to a gentleman who was telling me about a friend of his who was in worse shape than me. A year ago his friend had gotten implants. Last month she was diagnosed with breast cancer and lost both of her brand new boobies to the requisite double mastectomy.

I know that I’ve been through a lot but women who lose their breasts to cancer really humble me. I am SO not in their league by any stretch of the imagination. I saw what my Mom went through 26 years ago and she had Stage 2 so they took her lymph nodes as well AND she had chemo on top of it all. Not only did she lose her breasts but she also lost her hair.  Then she had her own necrosis complications after implants were put in. She still doesn’t have breasts.

Now that I’ve had such amazing results with my surgery she’s talking about getting hers done by Dr. Elliott. San implants of course. I wish that she would because I know what kind of self-esteem issues she has that are rooted in this. It’s a crying shame too because my Mom (who is single, BTW) is such a totally awesome lady. She deserves a bit more happiness in her life.

It’s because of people like my Mom, and what I’ve been through that I keep talking about this subject. There are so few places where anyone can FIND information about what happens when cosmetic surgeries go wrong. We feel ashamed, blame ourselves as though WE are the ones who did something wrong. I, personally, have felt less than human on numerous occasions because our society places so much value on breasts. I have wondered to myself that if I don’t have breasts, then what AM I? Surely not a woman. I felt like some mangled, sub-human thing. An “it”.

I play act very well. Most of the time the people closest to me had no idea of how I felt. Women are trained from an early age to put on a performance that will put everyone else at ease. As women, and especially Moms, we’ve been taught to put everyone and everything else ahead of our own needs. I think this is another reason why we don’t talk about these issues.

We have GOT to start being more vocal. These things are so much less frightening when you realize there’s someone out there who is going or has gone through exactly when you’re going though.

 

Nausea Part Deux

As you may have read in an earlier post, I’ve been battling nausea since waking up this morning. I finally managed to fight it into submission. Since he had to go run errands anyway, I sent Ken to pick me up some candied ginger. This is sweet and spicy at the end. Just about small 6 pieces and I was feeling much better.

I’ve also dropped my Percocet intake down to 1/2 a pill every 6-8 hours. I’m still at the same dosage for the muscle relaxer though. It’ll be interesting to see what comes of halving the Percocet as far as the nausea goes.

My appetite is still down but I managed to get down most of a bowl of spinache tortellini. There’s also a Nutty Bar in my future as well as the chocolate Tootie Pop I acquired at Dr. Elliott’s office.

Tomorrow morning we’re going to start the drive back to Florida. I’m honestly very nevous about being able to make the trip. I’ve been told that making frequent stops is helpful. I can only hope so. Worse comes to worse we can always stop somewhere along the way and try it again on Friday. I’ve been very fortunate so far so maybe I’ll be able to do it. Just keep your fingers crossed.

 

Second Check Up

I had another appoinment with Dr. Elliott this afternoon. His nurse took off all the tape over all my incisions front and back and took out the drain in my right breast. The engineering entailed in these drains is really rather amazing. They work on a primitive vaccuum principle. The last 6 inches or so that was inside my body had evenly spaced perforations. There is a long thin flexible tube that spans the space between that and a bulb about the size of a hand grenade. There is a little flip top on the top of the bulb through which the serous fluid, blood and tissue or white cells is emptied every 6 hours or so.

Once the drains have been milked into the bulb, then that substance is emptied into a graduated plastic cup with the same number as the bulb is marked with and the amount is then noted on a sheet. When drainage is less than 25 ccs in a 24 hour period, that’s when the drains can come out.

After the bulb is emptied, then it is compressed in on itself so that it is concave. This is where the slight vaccuum effect comes from.

***GRAPHIC CONTENT***

The drainage also changes color. The less bleeding there is, the more yellowish the fluid. Right now mine looks like ruby grapefruit juice. In the beginning it looked like a nice Cabernet.

I also found out that the stringy matter in the drains that I mentioned yesterday is either tissue or white cells that have died in  service to the immune system. A little scarrier option is that they could be clots.

The sensation of having barbed wire scraped through my armpits was also explained to me. I had presumed that the tunnell under my skin would be small. It isn’t. It’s the width of my underarm area. The nerves are still very, very raw from the tunnelling, which explains why some asshole is scraping me occasionally with a barbed wire saw.

*** END GRAPHIC CONTENT***

After the tape came off, Dr. Elliott came in and poked around. The flaps still look amazing and he’s very pleased with the results. I had a bit of trepidation though. Where the tape had been over the suture lines, there were a couple black spots. Those of you who have read my first entry will understand why this is unnerving. I was reassured that the black spots were only scabbing. There is absolutely of indication of necrosis. Indication of that would be darkening bruises and hardening or blackened skin. I have none of that. My bruises are lightening significantly to a lovely shade of spring green and light brown. So necrosis isn’t anything I need to worry about anymore.

From this point on, the tape gets changed once a week on Wednesday and I can shower with it on. What the tape does is to keep the incision scars from becoming thick and ropy by pressuring them to heal flat.

 

Nausea

As I mentioned in “Good Drugs”, my body tends to hold on to chemicals. So at this point I’m not sure if this nausea is still left over from the anesthetic or if it’s a result of the Percocet and muscle relaxer. I only took the Percocet this morning but that doesn’t mean that the muscle relaxer isn’t still in my system.

The bowl of Twigs, Flakes & Clusters seems to have made the nausea worse. I sent Ken down to the lobby to get me some Saltines. As any pregnant woman knows, Saltines are a total lifesaver. I’m really hoping that they will at least take the edge off.

What’s odd is that I’m still wearing the anti-nausea patch. It IS the third day so maybe I need to switch it out even though I didn’t have this until this afternoon. It is also possible that the patch only counteracts actual motion sickness.

I read in a few different places that the nausea could be caused by meds OR it could be that the fatty tissue in my body is still retaining some of the anesthetic from my surgery o Thursday afternoon.

The Saltines are definitely helping. Sleep will help more, I think.

 
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Posted by on April 22, 2009 in Uncategorized

 

Good Drugs

I’ve noticed that it can be difficult for me to be coherent with the Percocet and muscle relaxant I’m on. They make me…what’s the clinical term? Oh, yeah…FUBAR.  I generally have a 20 minute window between where the pain is lessened and I can write coherently. But it’s a slippery slope because by the time I’m ready to post, I’ve already dozed off a couple times. Or I’ve been distracted by whatever Ken has on TV.

It’s fascinating how some people have a much higher tollerance than others. I’m guessing it’s like drinking alcohol. Some can just handle more than others. *I* have a one drink limit. Chemicals tend to stay with me longer.

Back in the old days the anesthesiologist would have you count backwards from 100. I used to get all the way to 97 before I was out. Now they don’t have you count any more. They just give you Happy Juice to relax you  during pre-op then they take you into the OR and there’s a lovely little syringe and then you’re gone. Even though hours pass, it feels like just a few minutes.

While you’re coming back to consciousness, they also give you, if it was a major enough operation, a pain pump. Every 10 minutes you push a button and, like Pavlov’s dogs, you get a reward. It’s usually some Morphine derivative: a short duration major opiate/analgesic. It’s invaluable right before the nurse or tech strips the drains. That little bit makes sitting up and getting out of bed more than bearable.

The sore throat from the breathing tube tends to stay with me for a few days, too. The surgical team slides it down your throat right after you’re out and pulls it out right before you wake up so that your airway isn’t obstructed and they can give you oxygen during surgery.

 

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The First Check-Up

This morning I saw Dr. Elliott at his office for my first not-in-the-hospital check up. He’s extremely pleased with my results so far. According to him both of my flaps are “healthy and happy”. The swelling in my right breast has gone down some more so the skin feels softer and a bit more springy. We’re leaving that drain in until he sees me again Wednesday afternoon. Even though there is less than 25 cc of fluid in the bulb in 24 hours I don’t want to take a chance that the swelling is impeding drainage in that breast. The little bit of bruising by both armpits is also fading and has turned all kinds of pretty colors.

My mobility is better, too. I’ve figured out that rolling part way out of bed and then sitting up is far less painful and puts much less strain on the stitches in my back. I’m also actually walking at a good pace now. I’m not shuffling like the Old Hag from “Snow White”. These days I’m doing 3 laps around the hotel floor at a time.

Another observation I’ve made is that I know this sensation in my torso. It’s not always pain. It feels like I’m wearing a steel boned Elizabethan corset. My torso from just below my breasts to just above my waist feels like I’m packed into a sausage casing especially across my back. This is a standard M.O. for being corseted.

During the check up I reported having some nausea still. We’re not sure if it’s a lingering affect from the anesthesia still in my system, the car trip or the meds. So I got a few more sea sickness patches…the ones that go behind the ear. They cost about $50 for 4 and last 3 days each. For me, they are worth every penny.

Poor Ken. He’s been having to do so much for me, I finally shooed him out of the hotel room around 5 and told him to go have fun. I’ve got this great room all to myself and nothing but peace and quiet until he gets back. It’s so nice not having someone come in every hour or so asking to strip drains, take vitals or what have you. It’s just me, you and the chocolate Tootsie Pop I pilfered from the candy dish at Dr. Elliott’s office.

***GRAPHIC CONTENT***

Aside from regular reports on my status, I’d like you to be able to use this blog as a reference for your own experience. That’s why I occasionally go into more graphic detail about what’s going on with my own body and experiences.

It has been bizarrely interesting to see the changes in the drainage. The first day it was the color of a nice Cabernet. It has since faded to a red-tinged apple juice color.

For the last couple days there has also been this stringy matter that reminds me of chicken fat. On the one website I could find that mentions something ike this, it was theorized that it IS fat that didn’t get sucked out during the little bit of lipo he did. Some of it has been stringy and some has been little clumps of cottage cheese type matter. With what I observed during my initial healing process on the VAC machine, I’m guessing that it’s probably just fat.

 

Shower and Ravioli

I took my first shower a lttle while ago. The big mistake was in not taking any meds before hand. I was overdue for my muscle relaxer and I’m back to shaking like the last Autumn leaf on a tree. Surprisingly there was very little pain. Just weakness.  I managed to do everything except wash my hair.

The gauze around the drains was also changed. That wasn’t a big deal either. The worst part of the shower really was getting into and out of that mesh bikini thing that holds the drain bulbs. I’m just glad to be back in bed watching cheesy movies (The 5th Element) and sipping on Sparkling Lemonade from Trader Joe’s.

I’ll be due for another Percocet soon. I’m hoping the muscle relaxer won’t have knocked me out before it’s time for my pain meds.

Ken is making home made gorgonzola raviolis for me since I need something substantial. That will stave off any nausea from the percocet.

 
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Posted by on April 19, 2009 in Uncategorized

 

The Tortise, The Hare and Bessie

This morning Hubby milked and measured drains after I took a half dose of Percocet. Then we walked a lap around the hotel floor. Soon I’ll be getting drowsy again so I’m writing to keep this as up to date as I can.

The two front drains hardly have anything in them anymore. They’ll probably come out tomorrow at my  4 day appointment with Dr. Elliott. The swelling in my brand new right breast is going down. It’s not rock hard like it was before. The skin is so soft and smooth it almost has a baby’s newness to its texture.

I still can’t get over how BIG they are. I wasn’t kidding when I told Dr. Elliott that I would have been thrilled with a C cup. It’s totally possible too that when all the swelling is gone that my new breasts will be down in that range. Right NOW I think they look like stripper boobs.

That perception may well come from having nothing there but mangled lumps of scar tissue for 18 months. Every time I look though it’s another big surprise that there’s anything there at all. I’m guessing that any breast cancer or botched boob job survivor feels the same way.

I did a bunch of reading this morning at about 4 am. Various websites have put the reduction of swelling at anywhere from two to four weeks along with bruising reduction. I’m okay with the slowness as long as there’s no necrosis or infection.  After all, the moral of THAT story is that slow and steady wins the race.

Aside from the size, I’m also amazed at how quickly the breast drains have eased up. When Ken stripped the tubes that lead to the bulbs that hold the drainage there was virtually nothing in the breast bulbs. So that’s going much faster than expected.

This morning’s walk was also MUCH easier. It’s still hard to believe that I was in the OR less than 72 hours ago. It seems like so much longer.

For anyone having this, or similar, procedure done, I’m also going to describe how to milk the drains down into the bulb at the end. Your nurse or partner starts with a sterile alcohol pad right up next to the skin around the tube. Then, holding it VERY tightly he pulls the fluid towards the bulb with one hand while using the other to keep from yanking the drain out of your body. After stripping the first section, he’ll take the stripped drain section back up next to the body and slide the gauze down to the next section, inching the drainage down into the bulb. Then, once all the drainage is down in the bulb they open it, squeeze the contents into a plastic measuring cup and mark down how much was in the bulb.

Drainage consists mostly of serous fluid and a little bit of blood. I’ve been told that a tiny bit of bleeding is normal. If the color becomes dark red or if the bulb starts filling up REALLY fast, like within an hour or less, then I have to call the Doc because something bad has happened.

That’s one more reason to take it slow and appreciate the Tortise style of healing. Another aspect of taking healing slow is the Percocet and muscle relaxer. Those two tend to make me sleep and my body, as with most others, heals faster when I’m asleep.

Hi ho hi ho it’s off to a drug induced sleep I go.

Sleeping is another matter and I’ll deal with it in a separate topic some time during my recuperation.

 
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Posted by on April 19, 2009 in Uncategorized

 

The Ride To The Hotel

I got discharged from the hotel at 7:30 pm. The ride back to the hotel was pretty rough. I’m rather looking forward to when my muscle relaxant kicks in. Moving to get up just friggin hurts. Not as bad as Thursday but still pretty rough.

While Sara was teaching Ken to milk the drains, I got to see what the new girls look like. There may need to be revisions. I’m just going to wait and see after the swelling goes down.

They’re MUCH larger than I expected though. Right now they look like about a D cup. I would have been happy with a B and thrilled with a C. I’m guessing once the swelling goes daown hat they’ll be around a C.

I finally got to see what they look like. They aren’t precisely the ski slope breasts I requested but I am very pleased. I had Ken take photos for two days post op. We’ll take regular shots to keep track of the progress. Those pics, along with the other presurgical pics and necrosis shots will go up on the BoobCast web site when we find someone wiling to do it.

The muscle relaxant I took right after I got to the hotel is really helping so while I have the chance I’m going to go to the bathroom and then try to scoot over to the center of the bed further.

The flaps themselves look very healthy. It’s the other tissue that is bruised and needs to heal more. It’s looking good so far though.

 

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