Thursday, April 24, 2014

Stitch Glitch! - Diep Flap Reconstruction Week 4

Section of my tummy scar...healing nicely at 4 weeks!

I measured my abdominal scar. Guess how long it is?  If you said 23 - 1/4 inches, you are correct! Yes, my scar is nearly 2 feet long. Wow. That was a big incision.

I know I said week 3 was pretty boring, as far as recovery goes. Well, week 4 decided to add just a little bit of excitement. A piece of glue came off my incision on my abdomen and the incision was still a little sore there, and oozing a bit. I didn't think much of it, just put some gauze over it to protect my clothes and got on with the week. It got a little red, and kept oozing. There was a hole about as big as a pencil eraser. Throughout the week, it seemed to improve, and I was seeing my surgeon soon, so I just figured I would ask him about it. Monday morning (April 14) I went for a walk, and walked more normally than I have since surgery. It felt pretty good to be moving more easily. When I got home, the little opening had leaked more than before, and looked worse as well. I also had a reddened lump under my tummy incision nearby.

Some minor complications with an incision the size of my abdominal incision are not terribly uncommon. Tuesday morning (April 15) I went to see my surgeon and he took a look at it. All those stitches underneath my skin are in the process of dissolving (apparently they take about 6 weeks to disappear). Since I am at week 4, he said the stitches were breaking apart, and sometimes they can work their way near the surface. My body, in all likelihood, is reacting to a stitch and treating it as a foreign body, and thus, is not healing in that spot. He got gloves and a little packet of instruments and some gauze and told me he would remove the stitches that were causing the problem.

I couldn't really see what he was doing, as I was laying on the table at this point. I did raise my head once in awhile to check it out. I may not have been able to see everything, but I could sure feel it! He re-opened a little section of the incision, and probed around to find the stitches that were the culprits and remove them.

Me: "Ouch!"
Surgeon:  "Does that hurt?"
(Really??? You are cutting into a tender incision without any localized anesthetic!)
Me:  "Yes, a LOT."
Surgeon: "Sorry."

Don't get me wrong, my surgeon is incredibly gentle, but this did hurt. That Lamaze breathing from so many years ago still comes in handy!  I came home with iodized tape (for packing wounds) to put on the incision opening for 3-5 days, and then I will be putting Neosporin on it to keep it moist, covered with a piece of Aquacel (absorbent pad infused with silver to fight infection) while it heals. I also have an appointment in a couple of weeks to make sure it is healing well. The adventure continues!  Oh, and the doctor said, the reddened lump I was worried about was just skin irritation and some scar tissue forming underneath the incision. Scar tissue starts to peak, apparently, at 6 - 8 weeks. He said massaging the incision could help.

After 4 weeks, I am off baby aspirin and no longer have to sleep exclusively on my back. Since I am a side-sleeper, this makes me happy! I am wearing a compression garment during the day (I could probably write a whole post about my love/hate relationship with Spanx...but not today!) My doctor says I no longer have to wear the compression garment, but it does help with the swelling. He said I may want to wear one when being more active (going to the gym, hiking, etc.) over the next several months, as I will continue having the swelling for some time. He said in 6 months I will be mostly healed. But right now, I can increase my activity level and work on getting back to normal. Aside from my stitch glitch, things are progressing normally. Once the incision heals, I will probably meet with my surgeon in a couple of months to make a plan for phase 2, which will include any touch-ups to the new breast (NAC or nipple-areola complex), breast lift on my natural breast if I want it, any liposuction or fat grafting to improve symmetry, and any revisions to the abdominal incision. These touch ups are done on an outpatient basis with a 1-2 week recovery. Tattooing of the NAC complex takes place after phase 2 touch-ups have healed. I have heard that these revisions can take a good result to a great result. After all I have invested in this process, I think I am going for greatness!

Some people look at me like I am crazy to have gone through all of this, but let's put it in perspective. My cancer treatments and related procedures went from July 2012 - September 2013.  This reconstruction process with take up most of 2014. And then, I am done. No procedures down the road related to implants and their complications (capsular contracture, implant failure and replacement, etc.) If I am cured of cancer and live another 30-40 years or so, I say this is definitely worth it.  I am happy I am doing this. I am already pleased with the results.

For more on my Diep flap experience:
Diep Decisions! Diep Flap Reconstruction
Diep Flap Surgery & Recovery - Week 1
Diep Flap Reconstruction Recovery - Week 2
Diep Flap Reconstruction Week 3 - Recovery Can Be Boring

Wednesday, April 23, 2014

Africa, Hemorrhagic Fevers, Life and Death, and The Lassa Ward

Medical staff treating Ebola patient. Photo from lakareutangranser/Flickr.
An Ebola outbreak in Guinea has been in the news the last several weeks. Ebola is a virus that can cause hemorrhagic fever. It spreads through contact with bodily fluids of the infected host. There is no vaccine or cure for Ebola, so treatment strategies are usually limited to containing the spread of the virus. This latest outbreak has claimed 106 lives in Guinea, and prompted Senegal to close its border. Possible cases in places as far away as Canada tested negative for the disease, and health workers feel this current outbreak has peaked and is beginning to die down. Ebola is frightening for its horrifying symptoms and 90% fatality rate. The virus is associated with fruit bats, and spreads to humans from contact with infected animals.  Ebola is typically isolated to remote areas of central Africa, so the current outbreak in West Africa is unusual. I have paid more attention to this latest outbreak after reading a book called "The Lassa Ward," by Ross Donaldson.


In 2003, medical and public health student Ross Donaldson traveled to Sierra Leone to study a disease similar to Ebola, called Lassa (named after the Nigerian village where it was first identified).  While Ebola gets the most press, Lassa is no less lethal.  Donaldson chronicles his experiences in this well-written memoir. He went to Kenema, a small town in Sierra Leone near the Sierra Leone-Liberia border, to study Lassa. Many patients were refuges from the war in Liberia. The Lassa ward of the clinic/hospital complex in Kenema is run by Dr. Aniru Conteh. He has a small staff of assistants with limited nursing training. Donaldson struggles to adapt to the realities of medicine in this part of the world. Donated equipment languishes in a small supply room, waiting for someone to teach the staff how to use it. Medications like antibiotics can be purchased on the open market in town, but many families lack the few dollars necessary to acquire needed pills for their loved ones. It is a stark contrast to medical school and modern US hospital settings.

The book description reads:
In a hospital ward with meager supplies, Ross has to find some way to care for patients afflicted with Lassa fever... Forced to confront his own fear of the disease, he stands alone to make life and death decisions in the face of a never-ending onslaught of the sick who are inundating the hospital. Ultimately, he finds himself fighting not only for the lives of others but also for his own life.
Donaldson deftly weaves descriptions of the role of NGOs in the region, the benefits and limits of foreign aid, the devastating down sides of the diamond trade, and the political background of the area, into his narrative of his medical experiences in Kenema. His mentor, Dr. Conteh, leaves the young medical student in charge of the Lassa ward for a few weeks, and Ross is overwhelmed by the challenge. However, he soon learns to handle the crises, think on his feet, use his training, teach skills to the staff, and care for the patients. It is a steep learning curve, but in those few months in Sierra Leone, Ross transforms from a student to a physician.

The Lassa Ward in Kenema is the only Lassa isolation ward in the world.

I couldn't put this book down. I appreciated the way Donaldson writes about the people of Sierra Leone. He gradually comes to understand their perspectives, and through his writing, I found myself gaining similar understanding. In a country where infant mortality is high, and people who reach the age of 50 are elderly, it is no surprise that a different attitude exists about death and dying. "Dr. Ross" as the staff calls him, is watching and waiting by the bedside of a young patient. He describes the scene this way:
Dr. Conteh eventually returned from his meeting to find me still at Sia's bedside. I immediately felt relieved that the ward was back under his capable supervision and that I could return to my safe role as a medical student. But it still took my mentor's simple words to finally pull me away. "Not in our hands anymore," he said with the wisdom of many years. "Now God will have his way."
This acceptance of death, and of our limited capacity as humans to do anything about it, seems to give peace to the people Ross encounters in Sierra Leone. This attitude was one thing in particular that stood out to me as I read this wonderful book. The phrase "Now God will have his way" is a marvelous one.

Today, Ross Donaldson is a specialist in emergency medicine and global health. He is a doctor and medical professor at UCLA. Sadly, Dr. Conteh, who ran the Lassa ward for many years, contracted the disease from a needle stick, became ill, and died. Another physician has been found to run the Lassa ward, and Dr. Conteh's great work continues.

I highly recommend reading this book!

For more information check out  the Dr. Ross Donaldson website

Monday, April 21, 2014

Diep Flap Reconstruction - Week 3 - Recovery Can Be Boring

Even animals get bored....

I saw my surgeon again on April 1. He removed the 4 stitches and glue glob from my belly button. He also said I could start peeling off the surgical glue from my other incisions when it hangs loose.

Medically, here is a list of where things stand as I head into week 3:
Two more weeks of baby aspirin every day.
Two more weeks of the abdominal binder, although I can start taking it off at night if that is more comfortable.
Two more weeks of sleeping on my back. (My surgeon says after four weeks the transferred flap will have grown its own network of blood vessels, and will not be as fragile any more.) The body is pretty amazing!
Four more weeks until I can participate in vigorous activity.
No lifting more than about 10 pounds, no strenuous housework. Light housekeeping is okay.
Gentle stretches and motions with my right arm are okay.
Walking, walking, walking is good. Just nothing too vigorous.
Still avoiding caffeine (caffeine restricts blood vessels). I confess when my friend brought over amazing chocolate-marshmallow cookies, I indulged! So far, my flap is alive and doesn't seem to have suffered any ill effects, and those cookies were to die for!
I am still not quite standing up straight, but I am getting close.

I will follow up with my surgeon in two weeks, and then probably after a couple of months. The earliest touch-ups can be done would be 8 weeks after surgery. I think that will be too soon for me.  There isn't any rush. My doctor says the flap will shrink a little, as it doesn't have as robust a blood supply as it had when it was attached to my stomach. He says everything needs time to settle before we do any procedures to improve symmetry, create a nipple, make any corrections on the tummy incision, etc. Revision surgery is done on an outpatient basis, and the recovery is relatively short. I am almost done! When I think back to when I first met my surgeon in 2012, this day seemed very far away. Knowing I have made it--actually made it to reconstruction and took the plunge with a DIEP flap-- really makes me smile! I am also grateful to have worked with an amazing surgeon through this whole process.

Mentally, week 3 seems harder than week 1 and week 2. Those weeks I was pre-occupied with just getting through the surgery and the initial stages of recovery. Now I feel pretty good, but I am getting pretty tired of convalescing.  I am not in a lot of pain, but have twinges of soreness in my stomach and I have some random nerves that fire off occasionally in my newly created breast. This nerve pain is always weird, as my breast area is numb. However, this happened after the mastectomy, and I am assuming tampering with the pectoral muscle and removing scar tissue from the area has re-irritated those damaged nerves. I am still moving pretty carefully. I know I should tackle a few of those things I never have time to do (draw, cross stitch, etc.) and use my down time wisely, but I feel scattered and can't seem to concentrate very long on anything. I am reading a lot, but am bouncing from book to book (I am currently reading two non-fiction books, one novel, and listening to another novel on audio book). I wish I were standing up straight so walking around the neighborhood would be easier, and I am really, really sick of sleeping in the same position all night long on my back, and am finding it hard to get comfortable. Now that I am partially healed and the drains are out, I just have to wait patiently for my body to finish the healing process. And waiting patiently isn't my favorite thing. I know it is only for a few more weeks, and I also know I really want to protect my abdomen and flap after all I have gone through. It is important I take this time to heal, but it is sort of a boring process! I am not yet to the point where I miss doing housework...but I may get there...just maybe. I am very grateful that things have gone so smoothly, and that I am healing just like I am supposed to, so I really shouldn't complain.

But I might complain...just a little.

My Diep Flap journey:
Diep Decisions! Diep Flap Reconstruction
Diep Flap Surgery & Recovery - Week 1
Diep Flap Reconstruction Recovery - Week 2

Thursday, April 17, 2014

National Poetry Month - Song in a Minor Key by Dorothy Parker

Lady in the Park, 1897
(by Frederick Childe Hassam, American Artist, 1859-1935)

Song in a Minor Key

There's a place I know where the birds swing low,
      And wayward vines go roaming,
Where the lilacs nod, and a marble god
      Is pale, in scented gloaming.
And at sunset there comes a lady fair
      Whose eyes are deep with yearning.
By an old, old gate does the lady wait
      Her own true love's returning.

But the days go by, and the lilacs die,
      And trembling birds seek cover;
Yet the lady stands, with her long white hands
      Held out to greet her lover.
And it's there she'll stay till the shadowy day
      A monument they grave her.
She will always wait by the same old gate, —
      The gate her true love gave her.

Tuesday, April 15, 2014

Diep Flap Reconstruction Recovery - Week 2

Compared to my mastectomy surgery a year and a half ago, this surgery has seemed easier. I know I don't have the same emotional stress and anxiety that I had at the beginning of this cancer experience, and that really helps!

Drain cups on the bathroom sink.

I had surgery on Monday, March 17, and my first follow-up appointment with my surgeon was on Tuesday, March 25.  I named my three drains after track and field athletes, and the race was on to see which drain would be pulled first. Usain was clearly ahead, and FloJo and Carl (the abdominal drains) were a bit more productive. Before my appointment, I steeled myself to keep all three drains a few more days if necessary. My physician, however, reviewed my records and said all three drains were close to coming out. He decided to pull Usain and Carl! I was a bit surprised to keep FloJo, but her drain output had not been consistently going down. My doctor said there was some overlap with the abdominal drains, and that pulling one sometimes increased production in the other, so he told me he would leave FloJo in. If the production went down below  30 cc for 2 consecutive days, I could come in and have the nurse pull the drain.  Good news!

Track & Field star Florence Griffith Joyner - "FloJo"

Week Two had the excitement of drain removal, and I was standing up straighter. I did not take the walker to my doctor appointment, and soon abandoned it for use around the house. I sat up more during the day, still worked on walking around the house, and was generally feeling better.

I did have a couple of days where I felt icky. Not really nauseous, but I felt like I wasn't digesting foods very well, and felt bloated from the swelling. I ate carefully for a day or two, tried to get rest and fluids, and I much to my relief I started feeling better.

I had my third drain pulled on Thursday the 27th, 10 days after surgery. This really made me more comfortable! And, without drains, I was able to start wearing normal clothing (jeans and my own blouses rather than sweat pants and my husband's shirts).  Over the weekend, I even felt well enough to sit in locations other than my own home. I attended a play on Friday night, and went to church on Sunday. It was good to get out of the house! I am still using Tylenol and ibuprofen for "pain," but I feel more like I have a lot of discomfort rather than pain. I am usually more sore by the end of the day (and more swollen as well). I am still wearing the binder for compression on my abdomen. My doctor says I am a couple of days ahead of schedule as far as healing goes.

Week Two was also the first time I really took a look at myself to decide if I am happy with the results. I am starting to agree with my doctor that my stomach contour really will be nice (although I can't help wishing I had lost some weight before the surgery so it would be even better!) My belly button has some stitches in it and a bunch of glue, so it looks like it is filled with a dark glob right now. My breast mound where the flap was transferred has a good contour and looks pretty similar to my natural breast, even without the "touch up" surgery. There is an elliptical patch of skin in the front that looks a bit patchwork with the incision around it. That skin is from my stomach. Once the incision heals, it won't be nearly as noticeable. Right now it is ringed with surgical glue, which really accents the patchwork effect! I cannot get over how soft and natural my flap feels in my chest. I really do not miss that hard, full, saline tissue expander that has been my companion for over 19 months. I am really glad I had this surgery!

Surgery date:  March 17, 2014
Week 2 - March 24 - 30th

See my other blog posts about this journey:
Diep Decisions! - Diep Flap Reconstruction
Diep Flap Reconstruction Surgery & Recovery - Week 1