One Down, One to Go

I'm about a week and a half out from my mastectomy and it's already time for surgery #2, which will take place tomorrow morning, Monday, July 19th.  But now that I've been through one surgery, I know a little more what to expect. 

On the day of my mastectomy, my parents and I arrived at the hospital early - at 6:15am as requested.  We had to report to Ambulatory Surgery on the 5th floor - the same place I had to go for my liver biopsy months ago.  I signed in and took a seat with the other surgical patients and their families in the waiting room.  After a short time they called my name and I headed back and took a seat in one of the recliners in the "holding area" for surgery patients.

I got my wristband, changed into a hospital gown and then a nurse came by to ask me a host of standard questions.  Then they called my parents to come back and wait with me.

I didn't have to wait long, luckily.  Shortly after my parents arrived Dr. Samson came by to "mark me up".  He made a series of markings on my body with a purple marker - not places where they were going to cut (thankfully, because there were a lot of them!), just markings to help guide things I guess.

Then, the anasthesiologist came by to introduce herself.  She asked me a few questions then explained that I would be given a series of anasthesia drugs to keep me out for the duration of the surgery, and that they work as needed as far as duration - so once surgery is over, she can pretty much flick a switch to wake me up.  Of course, due to my anasthesia awareness fear, I asked if she could ensure I wouldn't wake up in the middle of surgery and she said that there are all kinds of monitors on me - heart, brain, etc. - that she keeps track of to make sure this doesn't happen.

I had to sign another consent form  for the anasthesia and then it was time to go.  I said goodbye to my parents and walked with the anasthesiologist back to where the operation rooms are.  Along the way she gave me one of those shower caps to put on my head to cover my G.I. Jane hair.  Then she led me to a gurney in the hall where I laid down. 

Since Roosevelt is a teaching hospital, a first-year resident was tasked with inserting my IV.  He was very determined but had a bit of a hard time... he did stick the inside of my elbow but I think he missed the vein or something because I don't think any blood came out (I'm not exactly sure because I didn't look).  The anasthesiologist came over to take a look and she took that IV out and put the IV in the back of my hand, apologizing along the way.  It really didn't bother me at all though because I am used to needle sticks!

While this was going on, Dr. Rosenbaum Smith came over all ready in her surgical scrubs and mask.  She said "fancy meeting you here" and asked how I was.  I said I was OK and she said that when I got into the OR, there would be a lot of people coming at me to put various monitors on me, but she said "don't worry, we won't do anything important until you're asleep in your happy place."  It was very reassuring to see and talk with her a bit.

Once the IV was in place I stepped down from the gurney and then walked with the doctors into the OR. I didn't look around too much because I was afraid of seeing a tray of scalpals or something that would freak me out.  But I did notice that the room was really large and very very bright - much brighter than how it looks on TV!  They asked me to climb up on the operating table and told me where to put my head.  Then I had to shimmy a bit here and there to get into the right position.  Dr. Rosenbaum Smith was right about various people coming at me to hook me up to monitors.

Then she said, "so where is the happy place you'll be going to?" and I said Bora Bora.  She said that sounded lovely and asked if I'd ever been there.  I told her that I'd been there twice since I have a client there and she said she wishes she had clients there too and that is the last thing I remember!  My parents later told me that when she came out to meet them after my surgery she told them that she thinks next time I go to Bora Bora I will need to bring my surgical consult.

The next thing I know, I felt like I was on a gurney that was being wheeled through the halls and I heard voices telling me to take deep breaths.  I felt like I was in a deep sleep and wasn't ready to wake up yet... like those mornings before school when my Mom would come to wake me up and I'd ask for "10 more minutes" (I never have been a morning person).  But then I remembered that I'd had surgery and I figured if people were trying to get me to wake up, I better listen to them.  So I made an effort to wake up and take deep breaths (even though I tried they still felt pretty shallow, but at least I was trying!).

When I woke up I found myself in the recovery room of the hospital.  I could only think of two things - one, that I really had to pee, and two, that I was really hot.  The first problem took a bit to fix - I felt like I had to pee but couldn't, which apparently is a side effect of anasthesia, but it wasn't too long before that system was back to normal.  For the second problem, the nurse took my socks off and affixed a fan to my bed to cool me down. Once these issues were resolved I realized that I did have some pain in my breast and upper arm.  The recovery room nurse, Rhea, asked me what my pain level was - I think I said 4.  She gave me a couple Percocets and they worked relatively quickly.

I was still really sleepy but I checked with the nurse before I let myself give in to it, since I remembered how when I was coming out of anasthesia they were trying to get me to wake up.  She said it was fine so I dozed on and off for most of the day, since there was really nothing else to do.  I ended up having to stay in the recovery room all day since it took forever for a patient room to open up - I didn't get moved to a room until 8pm that evening.  Apparently ever since St. Vincent's Hospital in NYC closed a couple months ago, the other hospitals have been absorbing the overflow and things have been busy.

Due to privacy issues, visitors are not really allowed in the recovery room, but my parents managed to come by a few times.  During one of their visits they were able to leave me with my iPod and my book since I was starting to get really bored just lying there all day.  Dr. Sara also came by to see me while I was in the recovery room, which was nice.

My night in the hospital was pretty uneventful.  I was able to sleep although I kept waking up when the nurses would come by for this or that.  I was not really in pain - I only needed the pain medication during the first day, but didn't need it by the evening and I was able to get out of bed to use the restroom myself (even though they asked me to call for a nurse to help me just in case) - which I had to do often because of all the fluids flowing into my IV.

The next morning a series of doctors came by to see me - mostly residents that work with Dr. Rosenbaum Smith.  Dr. Samson also came by and he said as long as I was comfortable with it, I could be discharged.  Of course I was fine with that so after the nurses showed me how to empty my drain and keep track of the output, I had to sign some papers and then I was on my way!

Recovery has gone well.  Although I didn't really have much pain - the day after surgery I took only one Percocet for the drive home and I think only one of the Vicodin prescription I had - I was sore and I had (and still have, to some degree) limited mobility in my right arm.  I am not supposed to move my elbow above my shoulder or do any heavy lifting or pulling.

I also have to sleep on my back - which I am not really used to, but I got used to it pretty quickly.  I propped myself up on multiple pillows - including one under each arm - and that seemed to help me get comfortable.

The drain was a nuisence, but it really wasn't too bad.  It was a long thin tube that was attached to my body with a stitch on the side of my chest, with a grenade-looking bulb on the end that caught the fluid.  Twice a day I had to "strip the tubing" (meaning making sure all the fluid in the tube got into the bulb), empty the fluid into a measuring container given to me by the nurse, and record the output on a sheet.  The drain was pinned to my surgical bra (so I didn't use a fanny pack after all!) the rest of the time.  The most annoying thing about the drain was that I couldn't shower while I had it in, so I had to get a little creative about washing while avoiding that area.

This past Tuesday, six days after surgery, I had my follow-up appointment with Dr. Samson.  My drain was removed at this time, since the output was really low and had steadily decreased since the day of surgery.  Dr. Samson's PA Samantha took it out - she warned me that it might burn while it came out but that she would do it really fast - like ripping off a band-aid.  She did take it out super-fast and I barely felt anything so it didn't hurt.  Once it was removed, I had to wait a day before I could shower, but that first shower on Wednesday was blissful!

Dr. Samson examined me and said everything looked good and that I should be ready for my first "expansion" next week.  He was very pleased with how much fluid he'd been able to get into the tissue expander during surgery, and although my right breast is smaller than my left, it is not a dramatic difference and I don't think anyone looking at me on the street would be able to tell unless they REALLY looked closely.  However, I still of course will need a series of expansions - where fluid is injected into the tissue expander through the port - before radiation starts.  Dr. Samson anticipates that I'll probalby only need 2 or 3 expansions total.  Since I am going to be in the hospital next week anyway, we decided that I'd have my first expansion while I am under anasthesia on Monday - convenient!

After my follow-up appointment with Dr. Samson, I was able to ditch the surgical bra and switch to a sports bra.  The post-op instructions from Dr. Samson's office had mentioned that Champion makes a sports bra that zips in the front (since due to my limited arm mobility I am only wearing button-down shirts), and my Mom had ordered a couple for this purpose.

On Friday, I had my follow-up appointment with Dr. Rosenbaum Smith.  She also examined me and was very pleased with how everything looked (as am I).  Then we talked about the pathology results.  She said she did not yet have the official pathology report, but that she'd spoken to the pathologist and had a verbal report.  There was still "quite a bit" of cancer found throughout the breast and I did have some positive lymph nodes.  What does this mean?  Well, of course it would have been better if no or very little cancer had been found, but it does not change anything as far as my treatment is concerned.  If anything, it just reinforces the need for radiation, which is designed to treat any cancer cells which may remain. Dr. Rosenbaum Smith said that I do have a higher chance of a local recurrance, but again, that is what the radiation is for, and I will see her every three months for the next two years (and then every six months forever after that) for clinical exams where she'll be looking for lumps, since when breast cancer returns it apparently always returns as a lump.

Once I am through the liver surgery I will be ready for radiation, and Dr. Rosenbaum Smith gave me the name of the radiation oncologist I will be seeing.  She said he is already well aware of my case - since he was consulted when the spots were found on the bone - and that it's time to go ahead and meet him for a consultation.  Time to add another doctor to my growing list!

I still have a little soreness and tenderness in my chest and upper arm, and my reconstructed breast itself is numb (which it will be for several months to a year), but as the days pass I feel better and better.  My Mom makes me take a nap every day to help get my strength back, which I've been doing diligently, and my sister and baby niece Claire came to visit for the week which was nice.  Of course, I wasn't able to hold Claire during most of her visit, but on the last day I picked her up a couple times and held her on my "good" side!

I've also had lots of friends and family friends come to visit, call, email, text, send cards and gifts, etc., and it has all been so wonderful.  I know I've said it before but I can't express enough how much I appreciate all the support!  It really does help, I believe.

Now I am turning my attention to my next surgery to remove the affected part of my liver.  On Friday, I had a pre-op appointment with my liver surgeon, Dr. Attiyeh.  He examined me first and then explained the surgery to my parents and me.  He would do a vertical midline incision - down to my naval - and would remove 2 sections of my liver, which is about 15%.  He said he has removed as much as 80% of the liver before - so in comparison it is not that much!  I will have no permanent effects (other than a scar of course) from the surgery and will be able to live a completely normal life and eat and drink whatever I like.  I said to the doctor that I understood there would be no long-term effects, but asked if there would be any short-term restrictions - like would I have to avoid alcohol for a time right after surgery.  It's not like I plan to booze it up during my recovery, but I was just wondering.  He said no and that I could have cocktails in the hospital if I want! 

Since we know the liver regenerates itself, my Dad asked the doctor how long it would take for the portion that was removed to grow back.  Dr. Attiyeh said it could be as quickly as two weeks, which shocked me!  He said it's not so much that the part that was removed "grows back" - it will always appear that part of it had been lobbed off - but rather it's that the remaining part expands to make up for the loss. 

Dr. Attiyeh said that I will need to be in the hospital for 3 or 4 days - so I likely won't be discharged until Thursday or Friday.  I asked if this was because of a risk for internal bleeding - which is why I had to stay in the hospital for several hours after my liver biopsy - and he said it was really because I would be in pain and that they would not send me home while I was in pain!

So I think this recovery is going to be a little more intense than my mastectomy, but I will get through it.  I will be very glad to have the surgery over with, because I know that every day after I will feel better and better.

As with my mastectomy, my sister will be "guest blogging" and will post updates on my status while I am in the hospital!  Thanks again to everyone for the continued support!