Farewell To Maya Angelou - 1928 - 2014

"Courage is the most important of all virtues, because without courage, you cannot practice any of the other virtues consistently."  -- Maya Angelou

Maya Angelou 

Today the news broke of Maya Angelou's passing. I enjoyed hearing interviews with her because she always spoke in a well-thought out, articulate manner. She was a self-made woman, rising above many challenges in life to become an accomplished author. I admired her mastery of language, and her ability to rise above difficulty, and her talent for putting it all into words. I heard her recite her poetry on TV more than once, and I can still hear her voice in my head saying "I rise, I rise, I rise."  Thank you, and farewell, Maya Angelou.

Still I Rise

You may write me down in history

With your bitter, twisted lies,

You may trod me in the very dirt

But still, like dust, I'll rise.

Does my sassiness upset you?

Why are you beset with gloom?

'Cause I walk like I've got oil wells

Pumping in my living room.

Just like moons and like suns,

With the certainty of tides,

Just like hopes springing high,

Still I'll rise.

Did you want to see me broken?

Bowed head and lowered eyes?

Shoulders falling down like teardrops,

Weakened by my soulful cries?

Does my haughtiness offend you?

Don't you take it awful hard

'Cause I laugh like I've got gold mines

Diggin' in my own backyard.

You may shoot me with your words,

You may cut me with your eyes,

You may kill me with your hatefulness,

But still, like air, I'll rise.

Does my sexiness upset you?

Does it come as a surprise

That I dance like I've got diamonds

At the meeting of my thighs?

Out of huts of history's shame

I rise

Up from a past that's rooted in pain

I rise

I'm a black ocean, leaping and wide,

Welling and swelling I bear in the tide.

Leaving behind nights of terror and fear

I rise

Into a daybreak that's wondrously clear

I rise

Bringing the gifts that my ancestors gave,

I am the dream and the hope of the slave.

I rise

I rise

I rise.

(Poem from And Still I Rise by Maya Angelou, copyright 1978, published by Random House.)

Stitch Glitch Part 2 - When to Call the Doctor & Wound Care

Packing strip for wounds.

"If it starts getting red and expanding out, call me," my doctor said before I left his office on April 15.
A few days later, I had a red rectangle forming to the left of my stitch abscess. The wound (nicknamed "Primordial Ooze") was responding well to treatment and looking much better, but what was causing the redness? My skin is pretty sensitive, and I chalked it up to irritation from pulling off the tape when dressing the wound.  I had another appointment scheduled on April 29, so I thought I would just keep an eye on it.

By the following Tuesday (April 22), it wasn't better. In fact, it was a little larger. And redder. And some skin was peeling, and there was a little lump that was sort of purplish and sore. I did not have a fever, but the area did feel warm to the touch. The clinic opened at 9am and I called and got an appointment for 11:15. If it was nothing, I was sure my doctor would tell me, and after all the work he put into this surgery, I was pretty certain it was better to have him look at it now than to wait until things got worse.

"It's a good thing you came in," he said.  He examined my red  incision area, thought for a minute, and then moved to the counter and started opening drawers."You're not going to like this," he continued.

"You want to open it up," I replied.

This time he used a local anesthetic (thank you!). Sure enough, there was some infection, and a couple more pieces of stitch to remove. Apparently my body likes to push out the stitches. Thankfully, at five weeks, they are almost all dissolved, so this shouldn't be an ongoing problem. My doctor gave me a prescription for an oral antibiotic to clear up the infection.. He assures me everything will heal fine and these abscesses won't affect the appearance of my scar. I just need to be a little patient while everything heals. Patience is a thing cancer patients get to practice quite often, so I am not too concerned about it.

I went home to start wound care. Now instead of one stitch glitch, I have three! Primordial Ooze is mostly a superficial wound now. I have not named the other two, although Frick and Frack come to mind.

Gathering supplies for wound care...good scissors help!

Here is my daily wound care routine.

• Collect all of my supplies (gauze, iodized wound packing tape (Iodoform Packing Strip by Curad), Aquacel (similar to silver alginate), gauze, tape, scissors, and tweezers). It is easier if you have everything ready before you begin.
• Remove the dressing from yesterday and throw it away. Rub off as much sticky tape residue as I can from my stomach.
• My first wound, which is more healed, gets an application of Polysporin (Neosporin would work just fine also), then gets covered with a strip of Aquacel (or silver alginate).
• The new holes get a piece of iodized packing strip placed in them with the tweezers. Wounds heal from the inside out, so each day, a little less of the strip fits down into the hole. When the wounds are as healed as the other one, I will just use the Polysporin and Aquacel on them, too.
• Cover the whole thing with gauze and tape it in place. Done for another day!

Aquacel

I am keeping my appointment on the 29th, just to make sure everything is healing fine. 

When to call the doctor:

Fever

Redness, especially if it is increasing

Redness that is warm to the touch

Signs of infection like pus

If you have any other concern with a healing incision or wound.

May 27, 2014
Update:  At my appointment (May 13) , things were healing well. He trimmed tissue and probed around one wound one last time before sending me on my way. I went back two weeks later (May 13), and my doctor said "It is healed. Wait at least 8 weeks more" (before scheduling my last surgery). So, I am still healing, but back in the gym, walking, and trying to figure out what my new normal is. Life after cancer treatment is full of some odd ups and downs, and some unexpected emotions, but I am finding my way through it one step at a time.

More on my reconstructive journey:
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
Stitch Glitch! - Diep Flap Reconstruction Week 4

Mary Anning and Her Remarkable Creatures - Happy 215th Birthday!

Ichthyosaurus

In 1810, a twelve year old girl and her brother found the first complete fossil of an ichthyosaurus. Her name was Mary Anning, and she lived in England. Mary was poor, self-educated, and an avid fossil hunter who often sold her treasures. She formed a friendship with Elizabeth Philpot, an older, middle class woman who collected fossil fish as a hobby. Mary mentions Elizabeth frequently in her letters, and it appears the two women went out fossil hunting together on a regular basis.  

Pleisiosaur

Little is known about these two woman, but Tracy Chevalier created a wonderful fiction novel depicting their friendship and discoveries.  Remarkable Creatures, published in 2009,  is a great book, and Chevalier writes sympathetically of Mary Anning's fossil discoveries, her dealings with the more sophisticated men who came to see her fossils and increase their scientific knowledge,  and her friendship with Elizabeth Philpot. Chevalier skillfully brings to life this wonderful story and early 1800s England. Mary gains a level of acceptance in the scientific world for her discoveries and knowledge. During Mary Anning's lifetime, fossil finds rocked the scientific and religious world. Paleontology was in its infancy. How did fossil finds fit into the creation of the world laid out in the Bible? What did the geologic record say? How could religion and science be reconciled? It was a challenging time to be a woman, fossil hunter, and self-educated paleontologist. 

Today, you can visit the town of Lyme Regis and see the beach and crumbling cliffs where Mary made her discoveries.  Many people used to visit Elizabeth Philpot's fossil fish collection in her home in Lyme Regis. Today, you can visit the Lyme Regis Philpot Museum. The museum houses more than just fossils, however. Jane Austen spent time in Lyme Regis, and even used the setting for part of her novel, Persuasion. The museum also boasts some Jane Austen items.

Beach at Lyme Regis

Mary Anning died at the age of 47 of breast cancer. The contributions she made to geology and science were certainly significant. Happy Birthday to this early paleontologist!

Mary Anning's headstone, Lyme Regis, England

Tracy Chevalier has great information about her book, Mary Anning, fossils, and more on her website.

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

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