Who Likes Liver Anyway?

Has it really been three weeks since my last post?  Oops, I guess I have been neglecting my blog during my recovery, but better late than never, right?

The truth is, a lot has happened in the last three weeks, and while recovery is going well, my energy levels just haven't been back to normal yet and I haven't really had the necessary combination of time and concentration to sit down and write until now.

So where did we leave off?  Oh right, I was just about to go in for my second surgery, to have part of my liver removed. 

The night before my surgery, my parents and I once again stayed overnight at the Holiday Inn just a couple blocks from the hospital, because I was due to arrive for surgery at 6am Monday morning.

We reported to the 5th floor Ambulatory Surgery department right on time.  Soon they called me back into the pre-op area, which I am now pretty familiar with.  They took my vitals, asked me all the same pre-op questions as last time, and asked me to change into a gown.

Then my parents were called back and we waited just a short time before the anasthesiologist came by.  She took me directly back to the OR, giving me a shower cap to put on my head along the way, and then set me up on a gurney in the hall just outside the OR doors.

She mentioned that I was very young for this surgery and went through the general plan for anasthesia.  She said once we were in the OR she would give me something to relax me (she said she's a good bartender!) and then once it was time she would of course put me completely out.

Then, someone came by to insert my IV - and they got it on one try this time, thankfully!  I also saw Samantha, who is my plastic surgeon's PA and was there to do the first expansion in my tissue expander while I was under anasthesia.  And of course, Dr. Attiyeh came by as well to see me before surgery.

I didn't have to wait long before they were ready for me and once again, I walked into the OR, trying not to look around too much, and climbed up onto the operating table.

I don't really remember much after this.  I do remember the anasthesiologist saying that she was administering the drug that would help me relax and I thanked her for this.  She said "I told you I was a good bartender!" and I don't remember anything else after that.

The truth is, I don't really remember much about the rest of that day.  I only have vague flashes of being in the recovery room.  I remember my nurse had curly brown hair, but I don't remember her name or anything else.  I remember when she gave me the clicker that I could press to give myself a dose of the painkiller they had me on, but I was too out of it to understand the instructions.  Not that they were hard - I just had to press it when I felt like I needed it, but I could only press once every 8 minutes (well, I could press the button as many times as I wanted, but it would only actually give me a dose once every 8 minutes).  This method is called a PCA - patient controlled analgesia.

I wasn't too keen on the PCA because I couldn't stay awake long enough to give myself enough doses to kill the pain.  So I would click, fall asleep, wake up in pain, click, fall asleep, wake up in pain, etc.  I kind of wish they would have just put me on something that I didn't have to think about, but oh well.

Anyway, unlike last time I did not have to wait in the recovery room for several hours for a patient room to open up.  Before leaving the recovery room, I remember the nurse expressing a bit of concern that I hadn't been pressing my PCA... but I was not even "with it" enough to think about pressing the PCA at that point.

Once I was in my room I mostly just slept.  When I did wake up, I was in pain.  It felt like I had had the absolute worst ab workout you can possibly imagine.  The most annoying part was that I couldn't take a deep breath because it hurt too much.  So when I woke up, I would instictively try to take a deep breath, then get frustrated when I couldn't, and the only way to not feel the pain was to fall back asleep, so that is what I did.

I also remember feeling that the backs of my knees were itchy, and I asked my parents to itch them for me a couple times.

At one point that evening either a resident or one of the nurses - I can't remember which - came by with a plastic breathing device.  It had a marker on it set to 1000 cc's and a little hose-like attachment that I was supposed to breathe into.  When I breathed in, a part inside the device inflated and I was supposed to get the marker up to the 1000 mark.  Right.  When they had me first try it I don't think it inflated barely 1 millimeter!  It just hurt too much to breathe in.  But they told me I should breathe into it about 10 times an hour (how was I supposed to do that when I was sleeping, I wondered) and that I should aim to get it up to 1000.  

The reason for this is that during surgery the air sacs in your lungs close up and this exercise is designed to help open them all back up, otherwise you can develop pneumonia.  But really it just gave me one more thing to think about, when I really didn't want to have to think about anything at all.

That night I slept a lot, but was also awake enough to press my PCA button more often.  When I woke up the next morning while the residents were making their rounds, I noticed that in addition to the backs of my knees, now my whole back was itchy too.  I mentioned this to the residents and they took a look (it was really hard to try to roll over) and said it looked red and I could be having an allergic reaction to the drug in the PCA (which was Dilaudid).

So they decided to take me off the Dilaudid and put me on morphine instead, and they said they were going to give my Benadryl to help fight the itchiness.  Of course I said "No!" to the Benadryl (because it gives me restless leg syndrome) and asked them to give my Hydroxyzine instead, which is what Oncology gave me after the Benadryl gave me restless leg syndrome during my first chemo session.

Once they took me off the Dilaudid and gave me the Hydroxyzine the itching started to wane, but it was really a couple days before it was completely gone.  So now, any time I am asked about drug allergies I have to say Dilaudid!

Despite the allergic reaction, I felt much better the day after surgery and was much more "with it".  After the morphine drip, they put me on Percocet and my pain was now under control.  I also did not have any nausea or vomiting, and I never had any signs of infection like a fever, etc.

I was on a foley catheter, which was very convenient because I remember how last time it was a little annoying to have to constantly get up to go to the bathroom because of all the fluids I was on.

They took out the catheter the morning after surgery.  The resident who took it out told me that I would have to pee within a certain number of hours and that if I didn't, they would be worried that I was retaining urine and might have to put the catheter back in.  I think this was the one job they gave to this resident, because she came back only a couple hours later to ask if I'd gone to the bathroom yet and I had to tell her that I hadn't even gotten out of bed yet!

I felt all this pressure to get up and go to the bathroom but luckily my nurse that day, Charmaine, said that I shouldn't worry because when they take out a catheter, usually it empties the bladder, so it would be a while before I had to go to the bathroom.  I even overheard her telling the over-zealous resident during one of her many check-ins to see if I'd peed that I "had time".

Charmaine was my favorite nurse.  She called me "pumpkin" and was very attentive.  She helped me get up for the first time - which didn't hurt as much as I thought it would - and took me for my first "walk" down the hall.

I was doing so well that the doctors said if I kept it up, I would probably be discharged the next day.  I had another decent night's sleep, and early the next morning the residents came by to change my bandages and take my drain out.  Yes, I had another drain, just like last time, but this one came out of my ribs.  I was glad that I wouldn't have to go home with this in and empty it myself, like I did with the mastectomy, but this one HURT when they took it out.  I'm not sure if it was because of where it was located or if the resident took it out too slowly, but I just took deep breaths until it was out and then it was over.

When Dr. Attiyeh came by later that morning, he said I would be discharged that day, since there was no reason to keep me longer.  My pain was under control, I didn't have any nausea, no fever or signs of infection, and I had even peed several times by then (which I'm sure made that resident happy).

During the next several days at home, I slept A LOT.  I took about two naps a day.  I took my painkillers only as needed - I think I only took them for a couple days after I got home.  For a few days, I walked like a hunchback.  This was either because I was subconsiously protecting my abdomen, or because the residents had re-taped my bandages too tight (or maybe a little of both), but I tried to make a conscious effort to stand up straight!

Two days after I was home, I was able to take my bandages off and look at my incision for the first time (and shower!).  It is a vertical incision that runs straight down my abdomen, stopping just above my belly button.  I had 15 staples in.  They didn't bother me too much although they did gross me out a little, just because I am not used to looking down and seeing staples in my body.  I was also terrified of having them get caught on something so I was a little protective of my belly.

By this point taking deep breaths was getting easier and while I didn't use my breathing machine nearly as much as they told me to, I did use it and did eventually get it up to 1000!  Laughing, coughing and sneezing also hurt for several days after surgery, so I tried to avoid any funny movies or TV shows.

But each day I would feel a little better, walk a little straighter, breathe a little deeper and as time went on I was able to tolerate laughing, etc., more and more.

For a few days every time I took a deep breath I had one specific area of pain on my right side, where the drain came out.  I started joking that I hoped it wasn't a Junior Mint that someone had dropped in me during surgery (like the Seinfeld episode!).  But after a few days I didn't feel it anymore though, so that was a relief - probably just related to where the drain came out, and not a Junior Mint after all.

A week after I got home from the hospital, I had a follow-up appointment with Dr. Attiyeh to have my staples removed. 

Dr. Attiyeh examined me and took my staples out and said everything looked good.  Then he gave me the pathology results of the lab tests done on the part of my liver that was removed.  The pathogy results showed that there was still some evidence of active cancer cells in the liver.  They were very small - microscopic - which is why they didn't show up on the PET scan, but the results justified the need for the surgery.  Dr. Attiyeh said that he got wide margins which were clean, so for all intents and purposes, it appears the cancer in my liver has been eradicated, which is great.

During the last few weeks, I have also had a couple appointments with Dr. Samson (my plastic surgeon) for "expansions" in my tissue expander.  The first expansion was of course done under anasthesia, but I have since had two additional expansions.  These are very quick appointments - I think I was only in the office for about 15 minutes each time.  Samantha, Dr. Samson's PA, does the expansions, and first, she puts a magnet on the reconstructed breast to locate the metal port under my skin.  This could be a cool party trick, I thought, but it didn't work so well when I tried it at home with a refrigerator magnet.  :)  Anyway, once she finds the port, she injects fluid into it with a needle.  The needle doesn't hurt because the skin is numb, but as the fluid goes in the muscle and skin is streched and that I could feel.  Each time, it was sore for about a day afterward, and I could even feel it getting in and out of bed at a specific spot in my back (since the muscle is all connected I guess).  But after a day or so, this faded.

The goal is to get the right side up to size to match the left - or actually slightly larger just to have some slack when the expander comes out and the implant goes in.  Dr. Samson thinks we are probably already there, so hopefully I will not need any more expansions.  I will have another appointment before the breast radiation starts to be sure, since ideally all the expansions will take place before radiation starts.

Speaking of radiation, that of course is the next step in my treatment plan. This past week, I met with the radiation oncologist, Dr. Evans, for the first time to learn the plan for radiation, and even had my first "targeting session" (I wasn't kidding when I said a lot has happened in the last few weeks!).  Turns out we'll be focusing on the spine first, and the breast radiation won't come until further down the line.  But I'll write more about that in a separate post (and I promise it won't take me three weeks this time!).

P.S. Giving credit where credit is due, the title of this blog entry came from my Aunt Patti and Uncle Bruce, who wrote this sentiment on the card that came with a beautiful bouquet of flowers they sent to my hosptial room while I was recovering from the liver surgery.  Cute, isn't it?  :)